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Table 1 Studies evaluating overdiagnosis

From: Overdiagnosis of mental disorders in children and adolescents (in developed countries)

Author(s) (year) Diagnosis N Study Result
First group of studies: re-evaluating former diagnoses
 Chilakamarri and Filkowski (2011) [26] ADHD, BD, MDD (DSM-IV) n = 64 patients (age 7–18) Re-evaluation of former diagnoses at intake in a community primary care mental health setting Overdiagnosis of ADHD, underdiagnosis of BD, over- and underdiagnosis of MDD
 Cotugno (1993) [27] ADHD (DSM-III-R) n = 92 patients (age 5–14) Re-evaluation of former diagnoses at intake in a specialized ADHD clinic 22% of former ADHD-cases were given a primary diagnosis of ADHD, 37% a secondary diagnosis of ADHD
 Ezpeleta et al. (1997) [24] DSM-III-R diagnoses n = 137 patients (age 6–17) Agreement between clinician-generated diagnoses at intake in an outpatient clinic and diagnoses given after a clinical interview Low to moderate agreement
 Jensen and Weisz (2002) [25] DSM-III-R diagnoses n = 245 patients (age 7–17) Agreement between clinician-generated diagnoses at intake in an outpatient clinic and diagnoses given after a clinical interview Low agreement, more diagnoses after clinical interview
 Krasa and Tolbert (1994) [18] BD (DSM-III-R) n = 53 patients (age 13–18) Re-evaluation of diagnoses after discharge from an inpatient psychiatric service 28.3% received an other diagnosis after re-evaluation (MDD, organic mood disorder, schizophreniform disorder, posttraumatic stress disorder, conduct disorder, ADHD, developmental receptive language disorder)
 Lewczyk et al. (2003) [28] DSM-IV diagnostic categories n = 240 patients (age 6–18) Agreement between discharge diagnoses generated by county mental health providers and diagnoses given after a clinical interview Low overall agreement;
higher prevalence of ADHD, disruptive behavior disorder and anxiety disorders based on clinical interview;
higher prevalence of mood disorders based on clinical diagnoses
 McClellan et al. (1993) [19] Psychotic disorders (DSM-III-R) n = 39 patients (age 7–17) Re-evaluation of diagnoses given at an inpatient psychiatric clinic after m = 3.9 years Diagnoses changed at follow up: 46% of schizophrenia, 66% mood disorder, 40% personality disorder
 McKenna et al. (1994) [29] Schizophrenia (DSM-III-R) n = 71 patients (age 8–18) Re-evaluation of diagnoses given at major academic centers 73% received a diagnosis other than schizophrenia after evaluation
 Pogge et al. (2001) [20] BD (DSM-IV) n = 29 patients (age mean 15.18) Agreement between clinical chart diagnoses at psychiatric inpatient clinic and research-quality assessment, involving structured interviews 40% of clinical chart diagnoses confirmed by research-quality assessment
79% of research-quality diagnoses confirmed by clinical-chart diagnoses
 Safer (1995) [21] DSM-III-R diagnoses n = 82 youth patients Comparison between inpatient and subsequent outpatient diagnoses Low agreement, inpatient: mostly mood-disorder diagnosis, outpatient: mostly disruptive behavior disorders
 Sevin et al. (2003) [30] DSM-IV diagnoses n = 150 adolescents (age 11–19) with developmental disabilities Comparison between pre-admission diagnoses and diagnoses made in a dual diagnosis treatment unit, serving adolescents with a developmental disability and a mental disorder Less externalizing, psychotic and mood disorders after re-evaluation, more Tic and substance related disorders
 Vitiello et al. (1990) [22] DSM-III diagnoses n = 46 patients (age 6–13) Agreement between chart diagnoses in a child psychiatry inpatient unit, diagnoses given after structured clinical interviews with the child and the patient’s parents and review diagnoses given after discharge by reviewing all relevant information regarding the child’s psychopathology Disagreement between chart and structured interview diagnoses in 1/3 of cases
Agreement between review-diagnoses and chart diagnoses: 67%
Structured interview (parents): 87%
Structured interview (children): 69%
 Werry et al. (1991) [23] Psychotic disorders (DSM-III-R) n = 61 patients (age 7–17) Re-evaluation of former diagnosis after m = 5 years 55% of bipolar diagnoses at follow up had a former diagnosis of schizophrenia
 Wiggins et al. (2012) [31] ASD (DSM-IV-TR) n = 1392 child patients Analysis of data from education and health records in surveillance years 2000 and 2006 4% changed in classification to non-ASD (mostly to language delay or disorder or other specific developmental delay)
 Wittchen et al. (1998) [32] Agoraphobia (DSM-IV) n = 173 patients (age 14–24) Re-evaluation of structured interview diagnosis by clinical psychologists Agoraphobia diagnosis was confirmed in 13.9% of cases; mostly patients received specific phobia diagnoses after re-evaluation
 Woolfenden et al. (2012) [33] ASD (DSM-III–DSM-IV-TR, ICD-9, ICD-10) n = 1466 child patients Review of 23 studies concerning stability of ASD diagnoses Moving out of the ASD spectrum at follow up with a former autistic disorder diagnosis (other ASD)
Baseline age <3 years: 0–30% (0–53%)
Baseline age 3–5 years: 0–20% (0–5%)
Baseline age >5 years: 0–16% (0–23%)
Second group of studies: designs able to prove overdiagnosis
 Bruchmüller et al. (2012) [34] ADHD (DSM-IV, ICD-10) n = 463 German child and adolescent psychotherapists Evaluating case-vignettes fulfilling/not fulfilling criteria of ADHD 16.7% diagnosed ADHD, although criteria were not fulfilled vs. 7.0% not diagnosed with ADHD although criteria were fulfilled
  1. ADHD attention-deficit/hyperactivity disorder, ASD autism spectrum disorder, BD bipolar disorder, MDD major depressive disorder