Department of Psychology, Miami University, Oxford, OH 45056, USA.
J Dev Behav Pediatr. 2012 Apr;33(3):221-8. doi: 10.1097/DBP.0b013e318245615b.
To evaluate the clinical utility of the cutoff recommendations for the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) comorbidity screening scales provided by the American Academy of Pediatrics/National Initiative for Children's Healthcare Quality and to examine alternative cutoff strategies for identifying and ruling out disorders commonly comorbid with attention-deficit/hyperactivity disorder.
A sample of 215 children (142 with attention-deficit/hyperactivity disorder), ages 7 to 11 years, participated in the study. Parents completed the VADPRS and were administered a diagnostic interview to establish diagnoses of oppositional defiant disorder (ODD), conduct disorder (CD), anxiety, and depression. The clinical utility of the VADPRS comorbidity screening scales were examined.
The recommended American Academy of Pediatrics/National Initiative for Children's Healthcare Quality cutoff strategies did not have adequate clinical utility for identifying or ruling out comorbidities, with the exception of the VADPRS ODD cutoff strategy, which reached adequate levels for ruling out a diagnosis of ODD. An alternative cutoff approach using total sum scores was superior to the recommended cutoff strategies across all diagnoses in terms of ruling out a diagnosis, and this was particularly evident for anxiety/depression. Several individual items on the ODD and CD scales also had acceptable clinical utility for ruling in diagnoses.
The VADPRS comorbidity screening scales may be helpful in determining which children likely do not meet diagnostic criteria for ODD, CD, anxiety, or depression. This study suggests that using a total sum score provides the greatest clinical utility for each of these comorbidities and demonstrates the need for further research examining the use of dimensional assessment strategies in diagnostic decision making.
评估美国儿科学会/国家儿童保健质量倡议为范德比尔特注意力缺陷多动障碍诊断父母评定量表（VADPRS）共病筛查量表提供的截断建议的临床实用性，并研究替代的截断策略，以识别和排除与注意力缺陷多动障碍共病的常见疾病。
本研究纳入了 215 名 7 至 11 岁的儿童（142 名患有注意力缺陷多动障碍）。父母完成了 VADPRS，并接受了诊断访谈以确定对立违抗性障碍（ODD）、品行障碍（CD）、焦虑和抑郁的诊断。研究还考察了 VADPRS 共病筛查量表的临床实用性。
除了 VADPRS ODD 截断策略外，推荐的美国儿科学会/国家儿童保健质量倡议截断策略在识别或排除共病方面没有足够的临床实用性，该策略在排除 ODD 诊断方面达到了足够的水平。使用总分的替代截断方法在排除诊断方面优于推荐的截断策略，对于焦虑/抑郁尤其如此。ODD 和 CD 量表的几个单项也具有可接受的诊断价值。
VADPRS 共病筛查量表有助于确定哪些儿童不太可能符合 ODD、CD、焦虑或抑郁的诊断标准。本研究表明，使用总分可最大程度地提高每种共病的临床实用性，并表明需要进一步研究在诊断决策中使用维度评估策略。
