UC San Diego: youth and caregivers disagree on psychiatric diagnoses in 11,868 ABCD study pairs
In the ABCD study, a diagnosis came from only one informant, youth or caregiver, in about 65–98% of cases; the authors say both reports are needed.
Researchers at the University of California San Diego School of Medicine and colleagues compared how youth and their caregivers report psychiatric diagnoses, according to today.ucsd.edu. The study was published on November 11, 2026 in JAMA Psychiatry. It analyzed reports from 11,868 youth and their caregivers from age 9 to age 17. today.ucsd.edu
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Study design
The data come from the Adolescent Brain Cognitive Development (ABCD) study, coordinated by UC San Diego and described as the largest long-term study of children's brain and behavioral development in the country. Youth and caregivers were asked the same diagnostic questions during separate clinical interviews.
The researchers derived a DSM-5 diagnosis from each youth's own report and from each caregiver's report. They then compared the two and tracked how much they overlapped for each diagnosis across developmental stages. Previous studies, according to the authors, focused on a limited number of disorders, such as depression or anxiety, at single points in time.
Where the reports diverge
Disagreement was the norm. When a diagnosis was reported, it came from only one informant, not both, in approximately 65% to 98% of cases, depending on the diagnosis and developmental stage. today.ucsd.edu
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Youth were more likely to report major depressive disorder, sleep problems, substance use, suicidal thoughts and attempts, and nonsuicidal self-injury. As teens got older, they reported depression more often than caregivers did. Caregivers were more likely to report conduct disorders, eating disorders, and generalized and social anxiety disorders. These gaps were widest at younger ages and narrowed as teens got older.
Agreement generally improved across developmental stages but remained limited, so discrepancies persisted throughout adolescence.
Corresponding author Laika D. Aguinaldo, PhD, MSW, assistant professor of psychiatry at UC San Diego School of Medicine, said that teens were more likely to disclose private, internal experiences, while parents more often reported externally visible problems. She noted that most parents do not know about their children's suicidal thoughts, self-harm, substance use and sleep problems. The authors conclude that information should be obtained directly from adolescents rather than from caregivers alone. today.ucsd.edu
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Future work will examine factors associated with youth-caregiver discrepancies and whether these differences influence access to mental health services and clinical outcomes.
