Wolraich Mark L, Lambert E Warren, Bickman Leonard, Simmons Tonya, Doffing Melissa A, Worley Kim A
Department of Pediatrics, Child Study Center, University of Oklahoma Health Sciences Center, Oklahoma City 73117, USA.
J Dev Behav Pediatr. 2004 Feb;25(1):41-7. doi: 10.1097/00004703-200402000-00007.
This study examines the impact of interrater reliability on the diagnosis of attention-deficit hyperactivity disorder (ADHD). A screening of 6171 elementary school children identified 1573 children with a high risk for ADHD according to teacher rating. Follow-up parent interviews and information from teachers were collected on 243 children. Before screening, health care professionals had diagnosed ADHD in 40% of the identified children. There was low agreement between the parent and teacher reports of ADHD symptoms according to DSM-IV-based questionnaires: Inattentive (r =.34, kappa = 0.27), Hyperactive/Impulsive (r =.27, kappa = 0.22), and Performance Impairment (r =.31, kappa = 0.07). When the two-setting requirement was strictly enforced, poor interrater agreement decreased diagnostic rates for all three types of ADHD in this clinical sample: Inattentive (15%-5%), Hyperactive/Impulsive (11%-3%), and Combined (23%-7%). Parent and teacher agreement was low concerning ADHD symptoms and performance. The recommendation of multiple informants significantly decreased the prevalence. Allowing for observer disagreement by using more lenient core symptom scores could reduce the effect.
本研究考察了评分者间信度对注意力缺陷多动障碍（ADHD）诊断的影响。对6171名小学生进行筛查，根据教师评级确定了1573名ADHD高风险儿童。对其中243名儿童进行了后续家长访谈并收集了教师提供的信息。在筛查前，医疗保健专业人员已对40%的已确定儿童诊断为ADHD。根据基于《精神疾病诊断与统计手册》第四版（DSM-IV）的问卷，家长和教师关于ADHD症状的报告之间一致性较低：注意力不集中（r = 0.34，kappa = 0.27）、多动/冲动（r = 0.27，kappa = 0.22）和学业表现受损（r = 0.31，kappa = 0.07）。当严格执行双背景要求时，评分者间较差的一致性降低了该临床样本中所有三种类型ADHD的诊断率：注意力不集中型（15% - 5%）、多动/冲动型（11% - 3%）和混合型（23% - 7%）。家长和教师在ADHD症状及表现方面的一致性较低。多名信息提供者的建议显著降低了患病率。通过使用更宽松的核心症状评分来考虑观察者间的分歧可以减少这种影响。
