Inquiring About the Bizarre: False Positives in Diagnostic Interview Schedule for

Children (DISC) Ascertainment of Obsessions, Compulsions, and Psychotic

Symptoms
NAOMI BRISLAlI, PII.D.

Abstract. This studv examines thr extent 10 which children misinterpret the intent of structured intcrvicv
questions about obscssions.compulsions, and psychotic' svmptorns, and it evaluates the implications of such errors
for cstimating the rate of psvchiatr«, svmptoms. The 'JIMII Diagnostic' Interview Schedule for Chiidrcn (DISC)
was administered to a sample of :'40 randoml. selected children and voung adults. Positive replies 10 questions
were rccodcd as negative when the cxamplc« indicated that the respondents misunderstood the intent of the
question The editing reduced the rate of obscssivc and cornpulsivc svmptorns by appruximatclv one third and
the rate of delusion', by a factor of :i to 10. Analysis of mothers' responses to the parent version of the DIS('
indicated that mothers made similar "crrorx " Suggcstions for improving the instrument include rcwording
questions to incorporate examples of abnormal behaviors, and enhancing interviewersunderstanding ofthe intent
of these questions. I .tnu-r Accu]. Child . Idol. l'svchiat., 19X7, :'6, 5:6.\9-644. Kc~' Words: structured diugnostic
interview, misinterpretation.

l lnlikc other psychiatric diagnoses that require the presence
of a varictv of relatively common moods and physiological
symptoms, obsessive-compulsive disorder and psychotic
symptoms arc characterized 11\ the presence of unusual and
bizarre behavior. Delusions and hallucinations arc <trangc
and ahnorrnal cxpcricnccs by definition. Obsessions and com-
pulsions arc thoughts or acts that in themselves may not he
unusual. but their intrusiveness, the sense of urgcnc , that
churactcri/cs them, and their uncontrollability transform
them into odd, incomprehensible behaviors.
'Ihe ascertainment of psychotic symptoms, obsessions, and
compulsions in nonp.uicnts (or community) samples IS par-
ticularly difficult. because most respondents arc not ac-
quaintcd with these rare phenomena. Compounding the dif-
flculty is the fact that the general categories in which these
abnormal behaviors Iall-s-c.g.. being preoccupied with un-
pleasant thoughts, or performing activities in a routine lash-
ion-arc within the range of common (normal) experience
and can. therefore, be mistaken for the abnormal variant that
is the psychiatric symptom. One approach. illustrated in some
scctions of thc NIMH-Diagnostic Intcrvicw Sclll'dule (DIS)
(Robins ct al.. 19X I ) is to dcscribc symptoms by thcir ddining
fcaturcs and to pnl\idc concrctc cxamples of commonly
rcportcd symptoms. The result is a long qucstion that first
dcscribcs a problem "somc pcople may hav'l'," and then asks
whcther the rcspondcnt has evcr l'\pnienced such a pmblem.
Dcspitc our intuitivc scnsc that long qucstions arc undcsirable,
prcsumably bccause they require a longer attcntion span and
grcall'r intcllectual compl'lcnce than most respondcnts can bc
cxpcctcd to havc. rcsearcll on interviewing has dcmol1'itratcd
thcir supniority: longer qucstions yield morc accuratc infllr-
N"("('lI','d,lIar, I'J, 11)8.', reT/II'II,lIa,. I. II),W, "lId,I/II"!1 :' I. 1'J8 7
"c("('/'/I'd , 1III'iI :''J. I 'J8-
/)r, lI,.nla/l /I /'mlnso,. 01 SOlwlog\", /)1'1'"rlllll'lIl 01 l'ITclllaI/T.
"lid is Ii/IO I\'ilh Ihl' /)I'/'III"/IIII'/ll of/'II'CIIlII/IT alld ('I'II/I'r lor '/'/,IIl'd
Nn('(/reh. ""/1/'.1' Fordllol/'ilal, :'7 1) 1) If I'sl (ir(///(I Hll'd. /)1'1,.oil, ,III
.J8:'IJ:'
/'rnl'/II<'l1 "I Ihl' ,11l1l//(ill/l'l'l/lIg ollhl' 111/('1'/'(/// ,1("(/(/1'/111' 01
('hild IlIId.ldolnc('//1 /\\"chiII/lT, ()('Iohl'r I:', /')8.J. ill Forei/lln
S/ll'/lnl'/l'd ill /,al'/ hi' .\'11/ gl'<llll III/) 1f>8:'1) "1/(/.\'11/11 N"II'areh
Scil'lI/isl /)1'1'1'10/)/1/('11/ . "\'Ill'll 1M):' ,1/IIIJIJ38IJ)
OX90-X56 7 IX7 j:'605-06.19$O:'.OO/O«> 19X7 by thc A mcrican Acad-
cmy of ('hild and Adolesccnt Psvchialry.
marion (Henson ct al.. 1977: Laurent. 1(72). Longer qucs-
tions apparently endow the interview with more importance
and thus provide a model for greater thoughtfulness on the
part of the respondent. Thcv might signil\ to the respondent
that the interviewer, by investing more time and effort in the
asking of the question. is more serious about the task (I Icnson
ct al., 1(77).
The NIMII-Diagnostic Interview Schedule tor Children
(DISC) uses a different approach. (The DISC was developed
under contract to N IM II by Barbara I lcrjanic, M .D.. Joaquim
Puig-Antich. M.D .. and Keith Conners, Ph.D.. in conjunction
with the staff of the Division of Biometry and l.pidcrniologv.
NIMH. The version used in this research was written and
validated under contract to NIMH by Anthony Costello.
M.D, and colleagues at Western Psychiatric Institute and
Clinic, Pittsburgh, Pcnnsvlvania (Costello ct al. 19X2. II)X4).)
The inquiry about the presence of a symptom uses a sequence
of short questions, The first question asks about the occur-
rence of a general category of behavior, and subsequent
questions inquire about specifi« qualifiers designed to elicit
the information necessary tl1r ruling in or out the psvchiatric
symptom. In addition, a positivc rl'ply to the initial question
is Il1110wcd by an opcn-cndcd qucstion asking rcspol1lknts to
l'\plain their answcr or to give an l'\ample.
Intervicw qucstions gcnnally clicit impn!l:ct data: rcspond-
ents may either 1~lil to report symptoms thcy havc actually
cxpcricnccd (1~lIsc ncgativ'cs) or nroncouslv rcport a symplom
thcy have not l'\perienced (1~t1se positivcs). Falsc ncgatilcs arc
morc likely than blsc positivcs to bc intcntionally produccd:
respondcnts are morc oftcn motivall'd to denv symptoms
than to invcnt thcm. but both types of error could result from
respondents' 1~lilure to underSland the intent of the question.
Thc lattcr problem would be cspecially se\'ere lllr obscssions.
compulsions, or psvchotic symptoms tllr thl' reasons listcd
abo\'c (unbmiliarity with thc rarc or the bi/arrc, and thc
overlap at a morc abstract Ie\'el with normalcxperil'nlT). This
suspicion was borne out to sOl11e l'\ll'nt in the :-.JIMII-DIS
l'alidity studics. where it was Illlll1d that agrcl'l11ent bl,tween
psychiatrists and lay interviewers on the diagnosis of obses-
siv'l'-col11pulsi\'l' disorder and schi/ophrenia was slightly lower
than the mean fln' all DSM-1I1 disorders c()\elnl in the DIS
(kappa fllr each was O.hO. whercas the I11can was O.h'l) (Rohins
640 IlR ESLAt l
c t a l.. 19XI) . In:J recent art icle . Pul ver a nd C:Jrpenter(19X3)
reported the pr esen ce of false negati ves in a survey of psy-
ch oti c sy m pto ms in patient populati on . They po inted out that
del iberate withholding of inf ormati on and impaired ca pacity
to d isclose information in full a rc particul a rly damaging to
the asscssrnc nt of bizarre symptom s. However. with respect
to these sym pto ms . our con cern sho u ld he primaril y with the
false positives. because in rare di sorders. such as obsession s.
comp ulsions. and psychoses. even a wry low false positive
rate results in a marked o veres ti ma tio n of the prevalence. a
po int rece ntly made with respect to the ascertainment of
psychotic symptoms by Heller and Robins ( 19X4).
There is also a concern that the rate of false positives ma y
be especially high when children a rc assessed . for they arc
more likely than adults to he sugge st ible both in the interview
situati on and in their general resp on se to stimuli. Moreover.
in c hild re n, it is harder to discriminate true obsessions and
compulsions from obsessive-like. ritu alistic behaviors that arc
part of normal development. For example. bedtime rituals
ar c known to be very comm on in young children. Also .
co nsu m ing preoccupations with sp ecific ideas or interests that
per sist IlH long periods are relativel y co m mo n among them .
with their games and so ngs c ha rac teri zed by ritu ali sti c repe-
titions (Rutter and Ciar rnezy. 19X3, p. XOI l. A similar blu rring
of the o rdi na ry and the a bno rm al ma y a pply also with regard
to so me psychotic symptom s.
Thi s paper addresses two questi on s:
I . To wh at extent do ch ild re n mi sinterpret the intent o f
DISC questi ons on obsessions. compulsion s. and psychotic
sy m pto m s'!
~ . Wh at a rc the implications of mi sinterpreting these qucs-
lion s for est im ating the rate of psychi atric sy m pto m s'!
Method
A probabilit y sample of J 60 ch ildren a nd young adults, X
to ~~ years of age . W:JS selected fro m C levela nd . Ohio and
surrounding suburbs. (The sa m ple se rved as :J control group
in a comprehensive study of childh ood chronic illncss.) Inter-
views were conducted at home by tra ined lay interviewers.
using sectio ns of the DISC that co ver 14 DSM-III diagnoses,
The parent version. DISC-P, W:JS administered to mothers.
The data reported here are on a subset of 240 randomly
selected c hild re n from the sa m p le. The 240 children were
evenly d istributed across the age ran ge. Se vent y-five percent
were white a nd 25 ':;, were black . Eighty per cent of th e mothers
were m arried a nd mean maternal ed uca tio n W:JS 12.7 ± 2.1
yea rs. Of the fam ilies, 16 ,51:;. had annual incomes below
15.000, 15':;, between 15.000 and 25.000. a nd 6 X.5% abo ve
25.000 (in 19X4 dollars),
T he DISC is a full y structu red inte rview sc hed u le that
spec ifics the exact wording and seq ue nce o f questions and
pro vides :J complete set of categories for clas sifying respond -
ents' replies (Costello et :JI.. 19X4). The highly structured
fo rm at is intended to minimize clin ical j ud gme nt in eliciting
diagn ostic information a nd record ing res po nses. It is designed
to be administered by lay interv iewers . trained to follo w
pr ecisely the interview schedule. As explained by the inst ru-
men t' s developers. "An abilit y to read fluently and naturall y
is the o n ly essential prerequisite" (Costello ct al. 19X4). Al-
though on many items in th e interview, children are asked to
de scribe :J beha vior or give ;111 ex ample. the cod ing o f re-
spo nscs is not affe cted hy these elab orati on s. The descriptions
a nd examples were used hy the de veloper s of the instrument
fo r the verification o f di agn oses of rare and se ve re di sorders.
Te st-retest and interrater rel iab ilitic s on parents' and chil-
drcn 's interviews have been high (sec su m ma ry of available
psychometric dat a in Orvaschcl. IlJX6. ) Te st-rete st reliab ilit y
of c hi ld ren 's reports o f sy m pto ms va ried hy age and by
sy m pto m area: reliabil it y was ge ne ra lly poorer in children
unde r 10 yea rs of age a nd in man ia. o bsess ive-co m pulsive
behavio r, and som e depressi ve features ( Fdclbrock et :JI..
19 X5).
In thi s study. we repli cated th e field methods used in the
validation studies of the DISC with respect to the selection of
interviewers. their training and supe rvisio n. and the admin-
istr ation of the instrument to ch ildren and parents (Costello
ct al.. IlJX4).
Error ra tes arc most commonl y assessed by comparing th e
results of one classification method with the results of another
method tak en as the criterion . T he a na lysis reported here.
howe ver . is not :J comparison of th e DISC against an inde-
pendent psychiatric e valuat ion . Instead . it is a com pa riso n of
DIS C results based o n ly o n information coded by intervie wers
with the results of the ed ited in forma tio n . using the descrip-
tion s a nd examples o f rep orted behaviors to determine
whethe r respondents misunderstood the intent of the ques-
tion . T he author. in consultat ion with :J clin ician -researcher.
ed ited all interviews. The editing consisted of c ha nging a "y es"
code to a " no:' when the ex ample ind icated that the respond-
ent mi sunderstood the intent of the qu estion and gave a
" false" positive repl y. When an exa m ple could he interpreted
as possibl y pathological , a ltho ug h a m biguo us . the ori ginal
positi ve code W:JS not changed . T hese e n tr ies we re examined
for their co nte nt. and a n a tte m pt was made to delineate
categories of mi sinterpretat ion . i.c.. common const ru ct s
(themes) that the DISC qu est ion s el icited. Such themes are
the competing entities that sho u ld he differentiated from the
psychiatric symptoms th at the interview questions seck to
elicit. In the 240 cases on wh ich this analysis is based, a
revi sion of :J "yes" to a "no" W:JS coded into a separate
ca tego ry . different from that ofan o rigina l "no:' enabling us
to me asure the overestimation o f sym pto m s caused by re-
spo nde nts' misinterpretation . The method is incapable o f
measuring the underestimat io n o f symptoms that resulted
fro m m isinterpretati on . That such e rro rs occ urred ca n no t he
ru led o ut. Their measurement an d th e info rm a tio n that could
provide insights for im provi ng the se nsi tivity of struc tured
quest ions by reducing mi sinterpret ati ons would require a
d ifferent approach .
Results
C'II/ego!'ies of Fals« Positi ves
Obsessions. Examples give n by c hild re n to illu strate their
po sitive replies to the DISC qu est ion " Do thoughts or pictures
yo u don't like e ver co me into yo u r head'!" can he c lassified
into four categories offalse posit ives. The first category groups
sta te me n ts about one's inabil ity to give an example (c .g., "I
ca n' t think of any now; I can 't de scribe it; I don't remember
an y") . The second category is o f vague statements that do not
 FALSI I'OSITIVIS IN TIlE DISC
describe a specific thought or image (c.g.. "Things flash across
my mind-depressing things: People I don't like"). The third
category comprises statements about unpleasant dreams, or
frightening movies or hooks (c.g .. "A dream about losing my
driver's license for speeding: A dream that things happen to
embarrass me: After watching 'The Day After' I kept picturing
it happening"). The fourth category is of statements about
brooding and worrying. It corresponds to the category of
behavior described in DSM-III text as obsessive brooding,
rumination, or preoccupation, behaviors that arc nOI true
obsessions hy virtue of lacking the quality of being ego-
dystonic in that they arc experienced as meaningful (c.g ..
"Past family problems: Insecurities-I imagine people think
poorly of me: Bad experience from the pas!").
Contpulsions. Examples given for two compulsion items,
"Do you have rules ahout things that you have to do over
and over?" and "Arc there things that you always feci you
have to do in exactly the same way'!", can he grouped into
three categories (in addition to the "no example" or "no
specific activity" categories, as in obsessions). The first cate-
gory comprises statements about tasks (activities) that arc in
nature highly routinized (c.g .. "My job routine in refereeing:
Long division: Setting the table: Games: Manners"), The
second category comprises statements about hahits that sirn-
plify life (c.g .. "My morning routine-shower first then break-
fast"). The third category is of statements about being orga-
nizcd as a personality characteristic (c.g .. "I need everything
to he precise: Everything I do-my room, school. writing").
Delusions about mind reading. Examples indicating false
positive responses to DISC items "Some people believe in
mind reading or being psychic. Have other people ever read
your mind'!" and "Have you ever read sornconc's mind?" can
he classified into two categories. The first comprises descrip-
tions of unexplained coincidence (c.g .. "I put down the same
thing my friend put down on an essay: My friend said the
same thing I was going to say"). The second category is of
inductive statements, that is, empirically grounded knowledge
of others' internal states-thoughts or moods-hased on past
observations linking overt behavior and appearance (c.g .. "I
have a good friend and if I'm depressed she knows what it is
about: My mother can tell what I think by the way I look: I
watch their faces and can tell what they arc thinking").
Similar themes were evoked hy the item tapping thought
broadcasting.
Thought insertion or withdrawal, Examples that indicated
false positive responses to the question "Has someone ever
put thoughts into your mind or taken them away'!" reflected
one general theme, namely, others' effort to influence the
respondent. This may take the form of persuasion, dissuasion.
or showing emotional support (c.g .. "About cutting school-
someone else had the thought and I took it: People tell you
to do something you don't want to hut you do it because they
convince you: When I feci sad. everybody cheers me up").
The misinterpretation involves taking the question metaphor-
ically rather than concretely.
Ideas otrctercncc. Examples given for false positive replies
to the question "Have you ever had messages sent just to you
through television or radio'!" indicated that children tend to
interpret this question too concretely (e.g .. "A friend dedicated
a song to me through the radio: My friend sent me a message
641
in Morse code: I know people at the station and when I
celebrate a birthday they say something").
Grandios« delusions (/w!ict.i ill f/ossl',I'sillg sticcial powers or
heillg one or IIII' II/OI! important !WI".\OIlS ill the world). Ex-
amples of false positive replies to the question "Have you had
some kind of special powers which make it possible for you
to do things that other people your own age can't do'!" can
he classified into two categories. The first encompasses de-
scriptions of accomplishments that surpass those of peers (c.g ..
'" can heat up the boys at school: I do the best work in my
class: I read better than others: I can do more in sports than
others"). The second category is of statements ahout special
talents or skills that arc not explicitly based on social com-
parison (e.g .. "My ability to draw").
The question "Have you ever felt that you arc one of the
most important persons in the world?" elicited similar themes
to those given to the previous question, hut in addition, it
elicited the theme of self-esteem and mattering, that is, the
belief that one matters to others, especially one's family
(Rosenberg and McCullough, 19XI) (c.g .. "No one is more
important to my self than me: I am important to my family").
FIll-CiS or.\Iisilll('r!JI'l'laliolls Oil IIII' Rail'
otPsvchiatric S\'II/f/IIJlIIS
The ascertainment of the psychiatric symptoms of obscs-
sions, compulsions, or delusions, according to the DISC al-
gorithms, requires information elicited hy sequences of ques-
tions. The initial DISC question ahout the presence of the
behavior is followed up by one or more subqucstions intended
to generate the information necessary to determine whether
the reported behavior is actually a psychiatric symptom. Thus,
for example, a positive answer to the question "Do thoughts
or pictures you don't like ever come into your head?" fulfills
the definition of an obsession only when it is followed by
positive answers to the following two questions: "Do you try
to make them go away'!" and "Docs it happen a 10("" The
effects of false positive replies to the initial question on the
rate of psychiatric symptoms was measured by tracing re-
spondents through a decision tree. which incorporates the
editing step into the DISC algorithm. (The diagnoses of DSM-
III disorders, as distinct from psychiatric symptoms, require
additional information on the duration of symptoms and the
impairment they have caused, and the DISC is designed to
generate information on these two criteria. The analysis pre-
sented here, however. is confined to the ascertainment of
psychiatric symptoms alone, not the disordcrs.)
The results for obsessions arc shown in Figure I. As can he
seen in this figure. 47.5"; (114) of the sample of 240 gave
positive replies to the initial DISC question. Of these, one
third (39) were judged to he false positives and were receded
into a separate code. In the last step, hoth the true and false
positives were classified according to their answers to the two
follow-up questions: those who answered positively to hoth
were grouped under "yes" and the remainder were grouped
under "no." False positives on the initial question yielded a
similar rate of obsession positives to the rate yielded by true
positives, 1Wi;, and 15':;, respectively. Children who gave false
positive replies to the initial question hut were not ruled out
by the follow-up questions constituted obsession false posi-
 BRFSIAlI

(DIS~ 201) on the obsession item and the three compulsion items and

r.
their associated follow-up questions. As can he seen. 51';;,
(12X) of the sample gave positive responses to at least one of
the four items. Of these. 67"; (X6) were JUdged to he possihk-
positives on one item or more. and 31";, (42) were judged to
Respondent" Ves have given only false positive replies. The combined results
No
Replie, 47.5~
52.5'" replicated those tor the individual items with respect to the
(126) (114)
proportion of positive replies Judged to he Ialsc-i-onc third.

A
Possbly talse
The false positives to the initial questions yielded I I false
positives for obscssiou/cnmpulsion. <;... ! the true positives
yielded 16 possible positives.
The results for one delusion-s-the h'b:; in one's mind

P,ychiat,1c
• Y!TJ>I om
1\7\IV)
No
85...
(64)
v.. No
15... 82...
(11) (32)
18
(7)
having been read-are presented in Figure .1. Here. a mark-
edly higher proportion. X0";., of the 1t11l1311V positive replies
were judged to he false, Editing out f;-lse positive replies

n.240
(DIS-C 20 1-204)

/\
Fatse positives

lu .. I. "Do ihouglus or pirtun-. \OU don't like ever rome Into vour
hl'ad"" Respondent.'
Rep/ie. No Ye.
44'"
(112)
63~
(128)
(DIS-C 2(2)

1'\
~atlIy False

A.A.
Respondent" No Vea
Replies 83... 7~
(223) (17)

Psychiatric
• YTT4ltoma
81...
(70)
19'% 7....
(16) (31)
26...
(11)
Po&Sbly False
"J( i ..\. Obscssior», compulsions.

7\1\
Of

(~209)

n·240
P.ychiatrlc No Ves No

/\
• ympt oms 58... 42... 40~
(7) (5) (2)

"1( r • 2. "1)0 \OU hav« rulc-, about thing-, that \ uu have to do mer and Respondent.'
over?" No Ve.
Repli•• eo... 1~
(215) (25)

/\
tivcs. The absolute ligufes arc 7 and I I for the false and true
obsession positives, respectively.
Results for one of the three compulsion items are shown
in Figure 2. The proportion of positive replies judged to he

i\A
blse was similar to the corresponding proportion in the
obsessions item. approximately one third in each, The rate of
initially positive replies was. however. much lower for the
compulsion item than for obsessions, 7"; and 47.:'1';. rcspcc-
P. ychiatrlc
tivcly. The l;tlse positives to the initial question produced • )'TTl)toma No Ve.
three cases of compulsion false positives. whereas the true Dow. 85...
(0) (13)
positive» produced live possibl« compulsion positives.
Figure J shows the results for l'ases with any obsessive- 1:1< t . 4. "Some people believe in mind reading or being psvchi«. Have
compulsive symptom. determined hy combining information other people ever read \,OUf mind?"
 h\I.SI' I'()SITI\TS 1:\ Till' DISC

TAIlII I . Estimutcs tI / S."'I//'Itl/I/ UII /<'.I : ()/>"' ,,iol/.l-( 'tI /I/ / I/I/ , i, JI /, ;\ unique aspect of the mothers' replies, however, wa s the
DISC "'tited high rate or " don' t know.' especiall y to quest ions on obses-
S~ mptom ( D ISC ltcm )
I'"; ) I'"; ) sio ns , till' belief in havin g onc s mind read , and th oug'u
Oh"',,iom 120 I ) 7.~ -I,ll
insertion or withdrawal.
Co m pu lsion', (202 ) .1.4 2.1
These observation s indi cate th ai the ascertainm ent prob-
( 'lll11pulsi'lil s (20 .\) U 1I.0 lcrns described above cannot be solved b y xubstitutiug moth-
( '1l 111pulsi ons (20-1 I O.lI 1I.0 l'I'S a s informants. The difficult y appears to be a characteristic
An y co m p ulsio n (202 -20-1) -I.1l 2.1 of'th c questions themselves rath er than o lc h ild rc n as respond-
(lhsession / l'lllllpui silln (20 1-211-1 ) 11 .2~ 1l.7 ems .

'1,\ 11 1 I 2. t .stnnot « tI/S"/l/I'l o/l/ UIII <'.I ,' iJ dl/litll/.l Conclusions

DISC
Svmptorn (DISC ltcm J
('"; )
Mind reading/llnl's own (20l)) 7. ~
Mind rcadi na/ su mconcs (210) u .o
Thou ght In",rtion/withdrawal (21 II h .~~
Thought broadcasting (212) X..\
SOJl1atic dclusion-, (21 ,1) 1 ,2~
Ilkas llt"reference (21-1) 2. 1
Spe cial pow l'l"S (21 ~) ~ .X
(irandi llsl' 12 1(, ) I 1 .2 ~
reduced muicriallv the rate or thi s symptom, be cause the lalse
positives would have added 13 cases to the live po ssibk
positives.
A summary or the dillL'rl'nl'l's in symptom rate between
the unedited and the edited DISC is presented in Tables I
and :::!. The rates or obsessive-compul sive symptoms wi thout
editing. a re generally one third higher than when replies are
ed ited . The d ifferences in the estimates o r the rates or delu -
sions are 1:11' grea te r: the un corrected symptom rat,' exceeds
HI"; in two types or delusions and more than 5"; in lour
others, whereas the corrected rate exceeds I/'; in only 11I1l'
type of delusi on-s-the belief in mind reading-s-whi ch had a
corrected rate of 2"; .
. ulditionaiAnulvsi»
lulsc positive replies to DISC questions on obsessions,
compulsions, and psychouc symptoms were distributed ap-
proximately l'Ll'nly across the ag.e runge. as further analysis
indicat ed , In other words. errors caused by misinterpretation
of questions were not confined to , or co nce n t ra ted in , the
10LLL'r ag.l'S, N,lle that the prL'\'iously rq10rtL'd ag.e depl'ndl'nt
nror rate ( h k lb ro c k l't a l.. IlJX5l was IiII' rdiability. not IiII'
blse po siti\'L's (i ,e.. \'alidity l. "I o te al so that the ,'videnn' that
rd iability \'aried markedly anoss symptoms indicates th:lt ,
OLL'r and abon' the obsl'l'n'd ag.L' \a riation s, questions about
certain sym p to m s tl'nd to di cit inconsistl'nt responses from
children in all ag.l' g.mups, a tindin g. cong.rul'nt with our lindin g.
that qUl'sti ons about bi/arre bl'ha\'ior tend to bl' mis lntl'l'-
preted by oldl'l' children just as orten a s b y yo u ng.l' r. MOfl.'OVl'r.
an examination o r mothl'l's' repli es, e lic ited \ia the parent
\'L'rsion or the DISC (DISC-I' l. ren'akd a sim ila r lel1lknc y to
m isinte rpret the items, Thus. Ii ,I' L'xampk. 5-t"; or 35 plhitin'
rl'plil's to the obsl'ssion qlll'stion , and (,lJ"; or 30 plhitiH'
replies to one o r thl' nllllpuision qUL'stions, were judg.ed to bL'
labl' when thl' l'xampks that accompan ied thl'm werl' nam -
inl'd . An a na lysis of the content o f till' nampks yiL'ldnl
similar tllL'mes to thosl' discml'l'ed in till' children's intl't'\ il'Lls.
"'tited The results of this analysis suggest se vera l ways tor improv-
I";) ing. the ability of the DISC 10 produce accurate information
2.0 on the presence or absence or rare a n d bizarre symptoms .
1.1I I. An attempt should be made to construct items in which
1.1I the abnormal behavior-the symptom -is described in detail ,
1.1I using longer questions . Information about the presence or a
i.o
symptom should probably 1/01 hI' requested or the respondent
lUI
before a complete description of the spec ifi c behavior is given .
1.1I
1\ report that some behavior, I:dsd y presumed to be the object
0 ,-1
or th e inq u iry, has been experienced is not always corrected
by follow-up questions: the respondent 's interpretation or
the se lolluw-up questions is likely to be colored by the first
m isinterpretation. Fur example. a po sitive an swer to the mix-
int erpreted compulsion question " A I', ' there things that you
always feel you have to d o in exactly the same wa v? " illus-
trat ed hy the example " Lo ng div isions" might lead 10 a fal se
pos itive sym p to m h v a posit ive answer to the ItllloLL·in g.lilllow-
up questions: "If you m ake :\ mi stake. do yo u haw to start
all o ver again '! Do you feel better when you han' d one it'.'
D o yo u think something had might happen if you don 't do
these things cxactlv right ? " That positive answers to these
qu esti ons arc logicall y p ossible in ref erence to " lo ng divi sion "
is obvi o us,
:::! . It could not. however. he a ssu m ed that young. children
would comprehend con cept s such as "unreasonable" or
"senseless" as features ofobsessions and compulsions. It mi ght
he ne cessary instead to provide for them examples or classes
or normal behavior as baseline. trorn which truly abnormal
thou ghts and acts should be discriminated. The cmpirically
derived cutcgorics of normal behavior mistaken lv elicited h y
the DISC questions can he used 1'\11' thi s purpose. The inquiry
about obsessions, Itll' l'xampk, should dl'scrihc anxiou s
thoughts. suc h as worries ahoul l:l ilin g in school somctimcs,
that are common eXpl'J'il'nl'l' li)1' a ll, Thc tl'l'm unrl'asonabk
,'o u ld he dl'snibed by an cx ampll' a bo u t h\.'havior thai cannol
hl' ul1lkrstood in a ml'ans-cnd rel alionship,
.I, It is also nCCl'ssan' to inst ru ci laL' inll'l'\'iewers morl' rull v
a bo ut Ihl' intent or spccilic I)IS( ' questions, again us ing the
empirically d erived ca ll'g.oril's or misintl'l'prl'tation. /\ \'agul',
nOllspccilic reply should he Il)lIowl'd hy a rl'qul'st lil[" a nlllrl'
l'I)J1l' rL'Il' answl'J': a COlllTl'tC an sw,'r that lit s a ditli:rl'nt type
o f hd1a L'ior rrom thc intl'nlkd sho u ld he It llhmnl by tL-cdhack
to thL' r\.'s polldcllt. rcstating. thc qu estion and l'iaril~ing its
illtl'llt.
-to Mor,','mphasis sht lu ld he placl'd lIn thl' task (II'rccording
l'xampks or positi\'l' an swl'J's . Dl,ta ikd cxampks arl' nccdl'd
fill' lktnmininl; whl'thn thl' rl'splll1lknt answl'J'l'd th e ques-
tion as intended or allrihutl'd a wrong. mcaning to it.
644 BRESI.Al~
It is important to emphasize that the editing of the DISC.
as illustrated here, is an inadequate solution. First it intro-
duel'S an additional source of error variance (caused by un-
rcliahilitv in editing), Second, and more important editing
the interview on the hasis of examples given by respondents
to their positive replies to symptom questions cannot correct
false negatives. A false negative statement ahout the presence
of a symptom cannot he distinguished from a true negative,
because at the conclusion of the interview the only informa-
tion that would he available is the recorded negative reply.
Furthermore, when a false positive is receded into a negative,
a correction based on the judgment that the respondent
misinterpreted the question, the assumption is that the correct
answer is negative. Although such an assumption is probably
warranted in most cases, given the very low rate of these
symptoms, there is no guarantee that some of these negative
respondents, known to have misinterpreted the question,
would not have given a true positive reply had they interpreted
the question as intended. Certainly, improved DISC questions
would reduce all errors, false positives and false negatives.
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