Department of Child and Adolescent Psychiatry, Children's Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614, USA.
J Dev Behav Pediatr. 2012 May;33(4):336-42. doi: 10.1097/DBP.0b013e31824afea1.
While American Academy of Pediatrics guidelines recommend obtaining symptom reports from both parents and teachers when treating children with attention-deficit hyperactivity disorder (ADHD), information from parents is easier to obtain and practitioners may prefer to rely solely on parent report when managing medications. There are, however, few empirical data on the relationship between parent and teacher reports during medication management of ADHD. This study examined the relationship between parent and teacher reports of symptoms of ADHD during a clinical trial.
A study to improve medication management of ADHD was conducted in 24 pediatric practices with 270 children. Children meeting criteria for ADHD were randomized by practice to treatment-as-usual or specialized care groups, with data combined from the groups to examine parent-teacher agreement. Parent and teacher reports on the ADHD Rating Scale-IV were obtained at pretreatment, 4 months, and 12 months follow-up.
At each assessment, correlations between parent and teacher ratings were statistically significant, but the magnitudes of the correlations were low, accounting for no more than approximately 17% of the variance between measures. Correlations between change scores on parent and teacher ratings were statistically significant but low for Total and Inattentive scales and not significant for the Hyperactive-Impulsive scale. For agreement on extreme scores, 6 of 9 kappas were statistically significant but all were unacceptably low.
Agreement between parent and teacher ratings of symptoms of ADHD is too low for clinicians to rely on parent reports while managing medications. Teacher reports are still needed to ensure optimal management.
尽管美国儿科学会指南建议在治疗患有注意缺陷多动障碍（ADHD）的儿童时同时获取家长和教师的症状报告，但获取家长的信息更为容易，从业者在管理药物治疗时可能更愿意仅依赖家长报告。然而，关于 ADHD 药物管理期间家长和教师报告之间关系的实证数据很少。本研究在一项 ADHD 药物管理的临床试验中，考察了家长和教师报告 ADHD 症状之间的关系。
在 24 家儿科诊所开展了一项改善 ADHD 药物管理的研究，共有 270 名儿童参与。符合 ADHD 标准的儿童按诊所随机分配至常规治疗组或专门护理组，将两组的数据合并以检验家长-教师间的一致性。在治疗前、4 个月和 12 个月的随访中，家长和教师均需使用 ADHD 评定量表-IV 进行评估。
在每个评估时间点，家长和教师评分之间的相关性均具有统计学意义，但相关性的程度较低，仅能解释测量值之间 17%左右的差异。家长和教师评分的变化分数之间的相关性具有统计学意义，但对于总分和注意力不集中分量表而言程度较低，而对于多动-冲动分量表则不具有统计学意义。对于极端评分的一致性，9 个 κ 值中有 6 个具有统计学意义，但均低得不可接受。
家长和教师对 ADHD 症状评分的一致性程度太低，临床医生不能仅依赖管理药物治疗时的家长报告。仍需要教师报告来确保最佳管理。
