Raiker Joseph S, Freeman Andrew J, Perez-Algorta Guillermo, Frazier Thomas W, Findling Robert L, Youngstrom Eric A
Florida International University, Miami.
University of Nevada, Las Vegas.
J Am Acad Child Adolesc Psychiatry. 2017 May;56(5):401-409. doi: 10.1016/j.jaac.2017.02.007. Epub 2017 Mar 6.
To use receiver-operating characteristics analysis to identify multilevel diagnostic likelihood ratios and provide a framework for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in children (5-10 years old) and adolescents (11-18 years old) in an outpatient setting.
Caregiver, teacher, and youth reports from the Achenbach System of Empirically Based Assessment (ASEBA) were obtained for 299 children and 321 adolescents with multiple imputation of missing data. The reference standard was diagnosis of ADHD based on case history and a semistructured diagnostic interview masked to the ASEBA measurements.
In children, caregiver-reported Attention Problems (area under the curve [AUC] = 0.74) outperformed all other subscales of the caregiver and teacher measures (AUCs ≤ 0.72). In the older sample, caregiver- and teacher-reported Attention Problems (caregiver AUC = 0.73; teacher AUC = 0.61) were best at identifying ADHD. Inclusion of caregiver and teacher reports significantly (p < .001 for all comparisons) increased prediction of ADHD diagnosis, whereas youth self-report did not.
Caregiver-reported Attention Problems were more useful than teacher-reports and self-report in identifying ADHD. Combining caregiver and teacher reports improved identification. Multilevel likelihood ratios are provided to facilitate routine clinical use.
运用受试者工作特征分析来确定多级诊断似然比，并为门诊环境中5至10岁儿童及11至18岁青少年注意力缺陷多动障碍（ADHD）的诊断提供一个框架。
从基于实证评估的阿肯巴克系统（ASEBA）中获取了299名儿童和321名青少年的照顾者、教师及青少年报告，并对缺失数据进行了多重填补。参考标准是基于病史和对ASEBA测量结果进行盲法处理的半结构化诊断访谈来诊断ADHD。
在儿童中，照顾者报告的注意力问题（曲线下面积[AUC]=0.74）优于照顾者和教师测量的所有其他子量表（AUC≤0.72）。在年龄较大的样本中，照顾者和教师报告的注意力问题（照顾者AUC=0.73；教师AUC=0.61）在识别ADHD方面表现最佳。纳入照顾者和教师报告显著提高了ADHD诊断的预测能力（所有比较的p<0.001），而青少年自我报告则没有。
在识别ADHD方面，照顾者报告的注意力问题比教师报告和自我报告更有用。结合照顾者和教师报告可提高识别能力。提供了多级似然比以方便日常临床使用。
