Department of Clinical Sciences, Lund University, Malmö/Lund, Sweden.
BMC Psychiatry. 2010 Jan 7;10:1. doi: 10.1186/1471-244X-10-1.
Reliable, valid, and easy-to-administer instruments to identify possible caseness and to provide proxies for clinical diagnoses are needed in epidemiological research on child and adolescent mental health.The aim of this study is to provide further validity data for a parent telephone interview focused on Autism--Tics, Attention-deficit/hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC), for which reliability and preliminary validation data have been previously reported.
Parents of 91 children clinically diagnosed at a specialized Child Neuropsychiatric Clinic, 366 control children and 319 children for whom clinical diagnoses had been previously assigned were interviewed by the A-TAC over the phone. Interviewers were blind to clinical information. Different scores from the A-TAC were compared to the diagnostic outcome.
Areas under ROC curves for interview scores as predictors of clinical diagnoses were around 0.95 for most disorders, including autism spectrum disorders (ASDs), attention deficit/hyperactivity disorder (AD/HD), tic disorders, developmental coordination disorders (DCD) and learning disorders, indicating excellent screening properties. Screening cut-off scores with sensitivities above 0.90 (0.95 for ASD and AD/HD) were established for most conditions, as well as cut-off scores to identify proxies to clinical diagnoses with specificities above 0.90 (0.95 for ASD and AD/HD).
The previously reported validity of the A-TAC was supported by this larger replication study using broader scales from the A-TAC-items and a larger number of diagnostic categories. Short versions of algorithms worked as well as larger. Different cut-off levels for screening versus identifying proxies for clinical diagnoses are warranted. Data on the validity for mood problems and oppositional defiant/conduct problems are still lacking. Although the A-TAC is principally intended for epidemiological research and general investigations, the instrument may be useful as a tool to collect information in clinical practice as well.
在儿童和青少年心理健康的流行病学研究中，需要可靠、有效且易于管理的工具来识别可能的病例，并提供临床诊断的替代指标。本研究旨在为先前报道过可靠性和初步验证数据的针对自闭症-抽搐、注意力缺陷/多动障碍（AD/HD）和其他共病（A-TAC）的家长电话访谈提供进一步的有效性数据。
在专门的儿童神经精神病学诊所被临床诊断为自闭症谱系障碍（ASD）、注意缺陷/多动障碍（AD/HD）、抽动障碍、发育协调障碍（DCD）和学习障碍的 91 名儿童的家长、366 名对照儿童和 319 名先前被临床诊断的儿童接受了 A-TAC 的电话访谈。访谈员对临床信息一无所知。比较了 A-TAC 的不同评分与诊断结果。
作为预测临床诊断的指标，访谈得分的 ROC 曲线下面积（AUC）对于大多数疾病，包括自闭症谱系障碍（ASD）、注意缺陷/多动障碍（AD/HD）、抽动障碍、发育协调障碍（DCD）和学习障碍，均在 0.95 左右，表明具有良好的筛查性能。为大多数情况下建立了灵敏度高于 0.90（ASD 和 AD/HD 为 0.95）的筛查截断分数，以及用于识别具有特异性高于 0.90（ASD 和 AD/HD 为 0.95）的临床诊断替代指标的截断分数。
这项更大规模的复制研究使用了 A-TAC 的更广泛的量表和更多的诊断类别，支持了先前报道的 A-TAC 的有效性。短版本的算法与大版本一样有效。筛查与识别临床诊断替代指标的不同截断水平是必要的。关于情绪问题和对立违抗/品行问题的有效性数据仍然缺乏。虽然 A-TAC 主要用于流行病学研究和一般调查，但该工具也可能作为临床实践中收集信息的工具。
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