What does it mean if Vanderbilt assessments are positive for a relative and negative for a healthcare provider?

Vanderbilt Assessment Interpretation: Positive Relative, Negative Provider

When Vanderbilt assessments show positive results from a relative (typically parent) but negative results from a healthcare provider (typically teacher), this discordance indicates context-specific behavioral manifestations that require careful interpretation rather than dismissal of either report.

Understanding Multi-Informant Discordance

The discrepancy between informant reports reflects a well-established phenomenon in behavioral assessment:

• Context-specific behavior patterns are the primary explanation for informant disagreement, where children genuinely display different behaviors across settings (home vs. school/clinic) 1

• Both reports contain valid information about the child's functioning in their respective contexts, rather than one being "correct" and the other "incorrect" 1

• False positives and false negatives can occur with either informant, but discordance more commonly reflects true contextual variation in symptom expression 1

Clinical Interpretation Framework

When Parent Reports Are Positive and Provider Reports Are Negative:

Consider these possibilities in order of likelihood:

1. Home-specific behavioral concerns that do not manifest in structured clinical or school environments 1

   • The child may exhibit better behavioral control in settings with external structure
   • Symptoms may be triggered by family dynamics or home stressors not present elsewhere

2. Normative comparison differences between informants 1

   • Parents may lack comparison to age-appropriate peer behavior
   • Healthcare providers/teachers observe the child against a broader normative sample of children

3. Relationship-based variations in behavior 1

   • The parent-child relationship context differs fundamentally from provider-child interactions
   • Duration and intimacy of relationship affects behavioral observations

Recommended Clinical Approach

Do not dismiss either report. Instead, follow this structured evaluation:

• Obtain detailed context-specific information from both informants about when, where, and under what circumstances behaviors occur 1

• Consider independent, context-sensitive assessment in the home environment if feasible, as this can help determine whether parent reports reflect true positives or false positives 1

• Evaluate for home-specific stressors including family conflict, parental mental health concerns, or environmental factors that may trigger symptoms only in that setting 1

• Assess the parent's psychological state and potential biases, as parental distress can influence reporting accuracy 1

Clinical Decision-Making

The positive parent report should not be ignored simply because the provider report is negative. The appropriate response depends on:

• Clinical severity and impairment reported by the parent in the home context 1
• Consistency with other available information about the child's functioning
• Presence of risk factors that would elevate concern (family history, developmental concerns, psychosocial stressors)

When to Proceed with Intervention:

Initiate evaluation and potential intervention when:

• Parent reports indicate significant functional impairment at home, regardless of provider observations 1
• The discordance itself suggests clinically meaningful context-dependent symptomatology
• Risk factors or family history warrant a lower threshold for intervention

When to Monitor:

Consider watchful waiting with follow-up when:

• Parent-reported concerns are mild and not causing significant impairment 1
• No additional risk factors are present
• The provider has adequate opportunity to observe relevant behaviors

Common Pitfalls to Avoid

• Never assume the provider report is more "objective" or accurate than the parent report simply because of professional training 1

• Avoid labeling parent concerns as "overreporting" without thorough investigation of home context 1

• Do not require concordance across informants as a prerequisite for clinical action when one informant reports significant impairment 1

• Recognize that brief clinical observations may not capture behaviors that occur in naturalistic home settings 1