注意缺陷多动障碍筛查工具在寻求物质使用障碍治疗的个体中的应用。
The utility of attention-deficit/hyperactivity disorder screening instruments in individuals seeking treatment for substance use disorders.
机构信息
New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, 1051 Riverside Dr, Unit 66, New York, NY 10032, USA.
出版信息
J Clin Psychiatry. 2012 Nov;73(11):e1372-8. doi: 10.4088/JCP.12m07895.
OBJECTIVE
Several screening tools for attention-deficit/hyperactivity disorder (ADHD) have been validated in non-substance-abusing populations, but limited data are available regarding their utility in adults with current substance use disorders. The aim of this study was to determine the sensitivity, specificity, and positive and negative predictive values of 3 commonly used ADHD screening instruments in cocaine-dependent individuals.
METHOD
Adults seeking treatment for cocaine dependence (N = 102) were administered 3 self-report instruments between May 2009 and April 2011: the Conners Adult ADHD Rating Scale (CAARS), the Wender Utah Rating Scale (WURS), and the Adult ADHD Self-Report Scale-Version 1.1 (ASRS-V1.1). They then met with master's-level clinicians who administered the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID). With the CAADID serving as the gold standard, the validity of the screening instruments was determined, both singly and in combination.
RESULTS
Twenty-five (25%) of the 102 patients met DSM-IV criteria for ADHD or ADHD not otherwise specified (NOS) based on the CAADID. Kappa scores determining agreement between the screening tools and the CAADID (with ADHD NOS labeled as ADHD or labeled as not ADHD) ranged from 0.37 to 0.69. Sensitivity scores for the broadest range of ADHD cases were 80.0%, 87.5%, and 60.9% for the CAARS, WURS, and ASRS-V1.1, respectively. Positive predictive value was highest for the CAARS, at 74.1%, and negative predictive value was highest for the WURS, at 95.1%. The highest sensitivity (96.0%) was found with coadministration of the WURS and CAARS.
CONCLUSION
While all of the screening instruments were found to have adequate sensitivity and specificity, the CAARS outperformed the other instruments in regard to agreement with the CAADID and positive predictive values. However, the WURS, with the highest sensitivity in regard to the broadest range of ADHD cases, may be the single best instrument for preliminary screening purposes. Further, because the ASRS-V1.1 is the simplest and shortest instrument to administer, it may have advantages when a large number of patients need to be screened.
目的
已有多种注意力缺陷多动障碍（ADHD）筛查工具在非药物滥用人群中得到验证，但有关其在当前物质使用障碍的成年人群中的效用的数据有限。本研究旨在确定 3 种常用于可卡因依赖者的 ADHD 筛查工具的敏感性、特异性、阳性和阴性预测值。
方法
2009 年 5 月至 2011 年 4 月期间，102 名寻求可卡因依赖治疗的成年人接受了 3 种自我报告工具的评估：康纳斯成人 ADHD 评定量表（CAARS）、温德 Utah 评定量表（WURS）和成人 ADHD 自我报告量表第 1.1 版（ASRS-V1.1）。然后，他们与硕士级别的临床医生会面，这些临床医生会进行第四版 DSM 中的康纳斯成人 ADHD 诊断访谈（CAADID）。以 CAADID 作为金标准，确定了筛查工具的单独和联合的有效性。
结果
根据 CAADID，102 名患者中有 25 名（25%）符合 ADHD 或未另作说明的 ADHD（ADHD-NOS）DSM-IV 标准。用于确定筛查工具与 CAADID 之间一致性的 Kappa 评分（将 ADHD-NOS 标记为 ADHD 或标记为非 ADHD）范围为 0.37 至 0.69。CAARS、WURS 和 ASRS-V1.1 用于最广泛的 ADHD 病例的敏感性评分分别为 80.0%、87.5%和 60.9%。CAARS 的阳性预测值最高，为 74.1%，WURS 的阴性预测值最高，为 95.1%。WURS 和 CAARS 联合使用时，敏感性最高，为 96.0%。
结论
虽然所有的筛查工具都具有足够的敏感性和特异性，但 CAARS 在与 CAADID 的一致性和阳性预测值方面优于其他工具。然而，WURS 在最广泛的 ADHD 病例方面具有最高的敏感性，可能是初步筛查的最佳单一工具。此外，由于 ASRS-V1.1 是最简单和最短的管理工具，因此在需要对大量患者进行筛查时，它可能具有优势。
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