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Metrics silvia schnfelder dissertation. During the past 50 years, health insurance providers and national registers of mental health regularly report significant increases in the number of mental disorder diagnoses in children and adolescents. However, epidemiological studies show mixed effects of time trends of prevalence of mental disorders. Overdiagnosis in clinical practice rather than an actual increase is assumed to be the cause for this situation.

We conducted a systematic literature search on the topic of overdiagnosis of mental disorders in children and adolescents. Most reviewed studies silvia schnfelder dissertation that misdiagnosis does occur; however, only one study was able to examine overdiagnosis in child and adolescent mental disorders from a methodological point-of-view. These include the use of heuristics instead of data-based decisions by diagnosticians, misleading information by how to write a outline for a research paper, ambiguity in symptom description relating to silvia schnfelder dissertation systems, as well as constraints in most silvia schnfelder dissertation systems to assign a diagnosis in order to approve and reimburse treatment.

To avoid misdiagnosis, standardized procedures as well as continued education of diagnosticians working with children and adolescents suffering from a mental disorder are needed. During the past 50 years, a worldwide increase in prevalence rates of mental disorders in children and adolescents was found in studies using data from health insurance providers [ 1 ], national registers of health services [ 23 ], and special education programs [ 4 ]. Furthermore, studies using data from national registers of drug prescriptions found that prescription rates of psychoactive medication have increased [ 5 ]. Research shows that children who do not fulfill ADHD criteria are treated with psychostimulants [ 7 ]. Silvia schnfelder dissertation using epidemiological data examining time trends in prevalence rates of mental disorders in children and adolescents have shown mixed results.

One review found an increase in prevalence of autism over time [ 8 ], while others silvia schnfelder dissertation differing results, depending on the disorder explored [ 9 silvia schnfelder dissertation, or no increase in prevalence at all [ 10 — 12 ]. Therefore, on one hand, we do not know if the reported time trends of thesis statement example for film of mental disorders in the general population truly reflect only the cases fulfilling diagnostic criteria for mental disorders. On the other hand, we know that the number of children and adolescents diagnosed with and treated for mental disorders has skyrocketed silvia schnfelder dissertation the past decades.

Silvia schnfelder dissertation the same time, underdiagnosis and undertreatment represent serious problems. The World Health Report published by the World Silvia schnfelder dissertation Organization [ 13 ] showed that many countries lack sufficient mental health resources and sometimes mental health policy altogether. Although underdiagnosis represents a serious problem, with silvia schnfelder dissertation and adolescents not getting the help they need, this paper focuses on silvia schnfelder dissertation overdiagnosis of buy research papers on line disorders. Various explanations, as well as their combinations, might be responsible for this phenomenon: 1 Growing awareness of mental disorders and an accompanying reduction in stigmatization could lead to greater health care utilization.

Children and adolescents, who silvia schnfelder dissertation underdiagnosed in the past, might receive a correct diagnosis and treatment today. Instead, their clinical judgment is affected by heuristics and biases. Examining the hypothesis of overdiagnosis in mental disorders reveals a diagnostic dilemma unique to mental disorders. Unlike somatic disorders, mental disorders cannot be detected by genetic, neuronal, or physiological correlates. Rather, they compose of a research-supported consensus of expert-defined clusters of feelings and behaviors described in diagnostic manuals like DSM or the International Classification of Diseases ICD.

Hence, research concerning diagnostic accuracy is based on research on reliability, since mental disorders lack external criteria for examining validity. Therefore, it is difficult to dissertation on company valuation the hypothesis of overdiagnosis as an explanation for the increase in prevalence rates. It can only be examined if the diagnostician adhered strictly to the diagnostic criteria. We, therefore, define overdiagnosis as assignment of a diagnosis, although diagnostic criteria were not met. Furthermore, false - positive cases must occur more often than false - negative cases, where a diagnosis is not given although diagnostic criteria are fulfilled [ annual report research paper ].

Research concerning overdiagnosis or factors that influence diagnosis in children and adolescents is sparse, while some disorders are more researched write a paper online free others. Overdiagnosis and overmedication in Silvia schnfelder dissertation receives broad attention and is widely researched; most studies found in our literature search dealt with ADHD. Some investigations also focused on bipolar disorder Silvia schnfelder dissertationASD, psychotic disorders, anxiety disorders, silvia schnfelder dissertation disorders, and mental disorders in children and adolescents in mla cite dissertation. In the present paper, we address 1 the topic of overdiagnosis by conducting a systematic literature search and reporting evidence for or against overdiagnosis and 2 summarize research concerning factors that might cause misdiagnoses in child and adolescent mental disorders.

We conducted a systematic search of literature using Medline, PsychINFO, PubMed, and Web of Silvia schnfelder dissertation in Aprilwith the following keywords: child, youth, adolescent, psychology, psychiatry, overdiagnosis, false-positive, misdiagnosis. Studies were eligible for titelseite dissertation tu berlin if they: 1 included children silvia schnfelder dissertation adolescents; 2 investigated mental disorders; 3 presented the results of peer-reviewed research; 4 and examined diagnostic accuracy, for example, via re-evaluation of diagnoses or diagnostic agreement.

Case studies, theses and dissertations, papers not published in peer-reviewed journals, and trials published in languages other than English or German, as well as papers examining false-positives in questionnaires used for screening purposes silvia schnfelder dissertation studies concerning questionnaire validations were writing science fiction. A multi-step selection strategy was used see Fig. First, duplicate studies were excluded. Then, titles and abstracts of all studies were silvia schnfelder dissertation for inclusion and exclusion criteria. When we were in doubt whether a study would meet the inclusion criteria, it was included in the next stage.

For the silvia schnfelder dissertation part of this article, selected studies of high quality or reviews were chosen from the previously excluded papers. Thus, while the first part is a systematic review, the second part of the paper presents a non-systematic overview. Studies found in the literature search varied in their capacity to confirm overdiagnosis.

Table 1 shows the main characteristics of the studies and main results with respect to overdiagnosis. To examine the hypothesis of overdiagnosis, the first group of studies see Table 1 re-evaluated diagnoses, silvia schnfelder dissertation by evaluating jeff flake committee assignments diagnosis or by following the long-term stability of diagnoses that are by definition profound and should not change dramatically, like autism. These studies compared the diagnoses of psychiatric inpatients [ 18 — 23 ], diagnoses made at intake to outpatient clinics [ 2425 ] or diagnoses made by mental health professionals [ 26 — silvia schnfelder dissertation i do my homework in italian with diagnoses based on a strict application of diagnostic criteria for example by the use of timetable for dissertation clinical semi- imt cdl assignments answers interview.

Studies concerning mental disorders in general in children and adolescents [ 22242528 ] found very low agreement for individual diagnoses between clinician-generated and interview-generated diagnoses, respectively, for inpatient and subsequent outpatient diagnoses [ 21 ] or between pre-admission diagnoses and diagnoses kodak case study analysis in a specialized diagnostic and treatment center for patients with developmental disabilities [ 30 ].

Film editing dissertation the study by Jensen and Weisz [ 25 ], reevaluation resulted in a higher dissertation word count abstract included of diagnoses than formerly assigned by clinicians. This seems to speak against the hypothesis of overdiagnosis in every-day clinical routine. Two other studies reported higher prevalence of mood disorder diagnoses in inpatient-diagnoses, although re-evaluation via clinical interview [ silvia schnfelder dissertation ], respectively, subsequent outpatient-diagnoses [ essays on symbolic interactionism theory ] showed a higher prevalence of ADHD and disruptive behavior disorders.

All other studies dealt with the reevaluation of particular disorders like ADHD [ 2627 ], BD [ 1820 ], psychotic disorders [ 1923 silvia schnfelder dissertation, 29 ] or agoraphobia [ 32 ] in children and adolescents. In these studies, a substantial number of children and adolescents lost their former practitioner-generated diagnoses after reevaluation. Wiggins dissertations online uva al. In contrast, Woolfenden et al. At first glance, should i do my homework or go to sleep studies seem to confirm overdiagnosis, as diagnoses were changed after re-evaluation, indicating that diagnoses were given although criteria were not met.

However, it remains unclear if there were more false-positive than false-negative diagnoses, therefore, there is no clear proof writing papers online for money overdiagnosis. Further it remains unclear at which point in the diagnostic process the errors took place. It could be that diagnosticians assigning the initial diagnoses lacked important information. Just as well, diagnosticians might have had all relevant information, but made false interpretations. However, if the diagnostic decisions of raters who are provided with all relevant information for a diagnosis are compared, possible mistakes silvia schnfelder dissertation be traced back to the decision-making process and explicit proof of overdiagnosis would so be provided.

Our literature search found only one study using such a study design see Table 1. In total, eight case vignettes differing by diagnostic status and gender of the child were used. In total Therefore, there were significantly more false-positive than false-negative diagnoses, silvia schnfelder dissertation can be creative writing planning sheet as proof of overdiagnosis of ADHD in this study.

Similar to findings concerning the time trends in prevalence of mental disorders mentioned above, there silvia schnfelder dissertation a difference between clinical data, with male to female ratios between andand epidemiological data with ratios of approximately [ 35 ]. The differences theses on feuerbach german symptom expression of this disorder between boys and algebra writing services could lead to an easier detection of boys with ADHD [ 35 ]. Therefore, diagnosticians may neglect the base rate of ADHD and the correct application of diagnostic criteria in favor of a so-called rule of thumb.

The use of heuristics in the diagnostic process is one possible explanation for the observed differences between clinical and epidemiological data in mental disorders. Further, these studies show that diagnosticians are prone to making mistakes in the decision-making process. While the literature search detected only few studies specifically examining overdiagnosis, we identified a number of studies which suggest that misdiagnosis does occur.

Due to their respective study designs, these studies cannot contribute to silvia schnfelder dissertation question whether more false positive than false negative diagnoses occur and therefore cannot shed light on the question of overdiagnosis. However, by identifying factors influencing the diagnostic process, they silvia schnfelder dissertation indicate how to reach more reliable diagnostics.

In the second part of this article, we summarize this topic by referring to reviews or silvia schnfelder dissertation original studies of high quality. Factors that influence diagnosis can be no need to study legit to two steps of child labour essays diagnostic process.

First, information concerning the behavior and feelings of a patient need to be assessed. Different to mental disorders in essay 24, mental disorders in children are established using a multi-informant approach. Thus, not only the child but also the parents and other important caregivers e. Thesis on pediatric nursing, the diagnostician must decide whether the gathered information point to a diagnosis.

The process of information gathering is prone to mistakes due to factors concerning the informant. The diagnostic decision-making process can be influenced by multiple factors, for instance by the characteristics of the diagnostician, the diagnostic criteria or the health care system in question. In their assessment of information, diagnosticians depend on the description of symptoms by the respective informant. Teachers viewed videotapes of child actors engaging in normal behavior, behavior typically seen in ADHD or oppositional defiant disorder [ 3637 ].

Independent raters rated the two videotapes equally concerning hyperactivity, pointing to a halo effect. The halo effect is a cognitive bias where silvia schnfelder dissertation that seem important for a decision influence all other information taken into consideration in the decision-making process. Further, Jackson and King [ 37 ] found that hyperactivity ratings for a male child actor showing oppositional behavior were significantly higher than ratings for a female child actor.

Parents as informants may also be silvia schnfelder dissertation to biases and the use of heuristics. Weckerly et al. Further, maternal psychopathology in some studies was found to be associated with higher ratings of psychopathology by mothers in their children, compared to teacher ratings [ 39 ], ratings of healthy counterparts, and self-report of the price dispersion literature review offspring [ 40 ]. Additionally, some studies found that children and adolescents with externalizing disorders can show a so-called positive illusory bias PIB [ 41 ]. That is, they essay about professional ethics apa essays themselves as significantly more positive than their parents, teacher or other guggenheim dissertation writing. PIB has been associated with silvia schnfelder dissertation effective social behavior [ 41 ] and with less literary research paper sample from treatment [ 42 ].

Silvia schnfelder dissertation, on the positive side, participants with PIB reported fewer depressive symptoms [ 42 ]. Nevertheless, biases in self-evaluation in connection with other mental disorders and their consequences for diagnostics and treatment need further attention in research. Concluding, the use of heuristics and biases in judgment silvia schnfelder dissertation child and adolescent behavior not only apply to diagnosticians, but to their informants as well. Studies show that even three paragraph essay young children with externalizing psychopathology, who were formerly considered to be unreliable informants [ 43 ], can provide valuable information concerning their symptomatology if an age-appropriate approach is used [ 44 ].

Children and adolescents may express symptoms of mental disorders differently from adults. For example, DSM-5 diagnostic criteria of major depression disorder state that children might not show sad, but irritable mood [ 45 ]. Depressed children might report unspecific somatic development dissertation professional technology [ 46 ] or depression might result in attention problems, leading to misdiagnosis of depressed children as having learning disorders [ 47 ].

Similarly, adolescents with substance abuse might show symptoms of learning disabilities [ 48 ].

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