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By Dennis P. Cantwell M.D., Gabrielle A. Carlson M.D. (auth.)

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Observation and interpretation variance occurs when clinicians, even though they elicit the same information and make the same observations, differ in what they remember and in how they interpret what they see and hear. Criterion variance occurs when there are differences in the criteria that clinicians use to make a certain diagnosis. For example, if a child has hyperactivity, inattentiveness, and impulsive behavior, and also may have some conduct disorder symptoms, some clinicians will diagnose both attention deficit disorder with hyperactivity and conduct disorder.

Therapeutic approaches in childhood depression. Presented at the Annual Meeting of the Canadian Psychiatric Association, Vancouver, Canada, 1973. McConville BJ, Boag LC, Purohit AP. Three types of childhood depression. Can J Psychiatr 1973; 18: 133-138. , Cytryn L. Urinary metabolites in chronically depressed children. JAm A cad Child Psychiatry 1979; 18:608-615. Phillips I. Childhood depression: the mirror of experience, interpersonal interactions, and depressive phenomena. In: Feuch AP, Berlin IN, eds.

A diagnostic formulation tells us what makes Patient A different from Patient B, even though they have the same clinical syndrome. 6. To be clinically useful, a classification system must provide adequate differentiation and adequate coverage. The "ultimate system" would be both jointly exhaustive and mutually exclusive. A patient would present with only one disorder, and all patients who walk through our doors would have disorders that are described somewhere within the system. We know from studies of adult psychiatric patients that as many as 25 percent receive a diagnosis of "undiagnosed mental disorder" (Goodwin and Guze, 1979).

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