Unreliable diagnoses (e.g., based on inconsistent criteria, subjective) may be inaccurate and even inequitable. This study uses an event history approach with yearly child- and school-level data from 378,919 children in a large urban school district in the southwestern United States between 2006–2007 and 2011–2012 to investigate contextual reliability in the designation of cognitive health conditions (e.g., autism, learning disabilities). This study’s findings suggest the likelihood of designation is higher in schools with more resources (higher teacher-to-student ratio, student population with more resources at home, charter school or magnet program), controlling on student-level differences. Cross-level interactions suggest children’s likelihood of designation also may be higher if they are distinctive relative to other students in their school, sometimes even in terms of nonclinical qualities (race, English Learner status).

中文翻译：

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美国儿童认知健​​康状况指定中上下文可靠性的多层次调查

不可靠的诊断（例如，基于不一致的标准，主观）可能不准确，甚至不公平。这项研究使用事件历史方法，并结合2006-2007年至2011-2012年间美国西南部大型城市学区的378919名儿童的年度儿童和学校水平数据，调查了认知健康状况指定的背景信度（例如自闭症，学习障碍者）。这项研究的发现表明，拥有更多资源的学校（师生比例更高，在家中拥有更多资源的学生人数，特许学校或磁悬浮课程）被指定的可能性更高，可以控制学生水平的差异。跨层次互动表明，如果孩子相对于学校中的其他学生而言与众不同，被指定的可能性也可能更高，