Parental awareness of substance use among youths in public service sectors.

OBJECTIVE: When asked about substance use, youths typically endorse higher levels of use than parents, suggesting that parents are often unaware of their child's drug and alcohol use. This study sought to examine the level of concordance between reports of youths enrolled in public sectors of care and their parents, and identify potential predictors of parental awareness of substance use and related problems. METHOD: Youths receiving services in one or more public sectors of care (N = 985; 67% male) and their parents were interviewed about the youths' substance use and substance use problems, as well as associated demographic, parental, and youth factors. RESULTS: As has been found in other studies, youths generally reported higher rates of substance use and substance use problems compared with parents. Rates of agreement ranged from κ = .24 (sedatives) to κ = .67 (marijuana) and were higher for drug problems (κ = .47) than for alcohol problems (κ = .34). Predictors of parental awareness of drug problems included youth gender (male), race (White compared with Hispanic), and higher ratings of youth's functional impairment. Predictors of parental awareness of alcohol problems included race (White compared with Hispanic), lower levels of youth-reported parental monitoring, lower levels of parental depression, and higher ratings of youth functional impairment. CONCLUSIONS: In this high-risk population, a significant proportion of parents are unaware of their child's alcohol (30%) and substance use (50%) problems. Services geared toward enhancing parental awareness, especially for parents of Hispanic and female youths, may increase communication and treatment seeking.

Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers.

BACKGROUND: Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention. METHODS: Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis. RESULTS: Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years. CONCLUSIONS: These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.