Physicians' recognition of psychiatric disorders in children and adolescents.

We examined the ability of physicians to recognize psychiatric and behavioral problems in the children and adolescents under their care. The report by 35 physicians of psychopathology in their patients was compared with the reports of parents and of children which were derived from direct and independent assessments of the children and of parents about their children. Physicians' reports of psychological problems were also compared with reports by a child psychiatrist who used all available data on the children and made a best estimate diagnosis. Agreement between the physicians and any of the three other sources of information--parents, children, or child psychiatrist--was poor, with kappa ranging from -15 to .11. Physicians tended to underreport both minor and serious psychiatric problems in children. These results are discussed in the context of the recent American Medical Association initiative to improve the health of children and adolescents.