Gordon Michael, Antshel Kevin, Faraone Stephen, Barkley Russell, Lewandowski Larry, Hudziak James J, Biederman Joseph, Cunningham Charles
Upstate Medical University, Department of Psychiatry, Syracuse, NY 13210, USA.
J Atten Disord. 2006 Feb;9(3):465-75. doi: 10.1177/1087054705283881.
Diagnosing ADHD based primarily on symptom reports assumes that the number/frequency of symptoms is tied closely to the impairment imposed on an individual's functioning. That presumed linkage encourages diagnosis more by Diagnostic and Statistical Manual of Mental Disorders (4th ed.) style symptom lists than well-defined, psychometrically sound assessments of impairment. The current study correlated measures reflecting each construct in four separate, large-scale ADHD research samples. Average correlation between symptoms and impairment accounted for less than 10% of variance. Symptoms never predicted more than 25% of the variance in impairment. When an ADHD group was formed according to a measure of current symptoms, the sample size shrunk by 77% when a criterion-based measure of impairment was added. The partial unlinking of symptoms and impairment has implications for decisions about the diagnostic process, research criteria for participant inclusion, prevalence estimates, gender ratios, evaluation of treatment effects, service delivery, and many other issues.
主要基于症状报告来诊断注意力缺陷多动障碍（ADHD），这意味着症状的数量/频率与个体功能所受损害密切相关。这种假定的联系更多地是通过《精神疾病诊断与统计手册》（第4版）中的症状列表来促进诊断，而不是通过对损害进行明确界定且心理测量学上合理的评估。本研究在四个独立的大规模ADHD研究样本中，对反映每个构念的测量指标进行了相关性分析。症状与损害之间的平均相关性所解释的方差不到10%。症状对损害方差的预测从未超过25%。当根据当前症状的测量指标形成ADHD组时，若加入基于标准的损害测量指标，样本量会减少77%。症状与损害的部分脱钩对诊断过程的决策、参与者纳入的研究标准、患病率估计、性别比例、治疗效果评估、服务提供以及许多其他问题都有影响。
