Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
J Child Psychol Psychiatry. 2022 Feb;63(2):229-237. doi: 10.1111/jcpp.13440. Epub 2021 May 27.
A diagnosis of attention-deficit/hyperactivity disorder (ADHD) requires the presence of impairment alongside symptoms above a specific frequency and severity threshold. However, the question of whether that symptom threshold represents anything more than an arbitrary cutoff on a continuum of impairment requires further empirical study. Therefore, we present the first study investigating if the relationship between ADHD symptom severity and functional impairment is nonlinear in a way that suggests a discrete, nonarbitrary symptom level threshold associated with a marked step increase in impairment.
Parent reports on the ADHD-Rating Scale (ADHD-RS-IV), the Weiss Functional Impairment Rating Scale (WFIRS-P), and the Strengths and Difficulties Questionnaire were collected in a general population sample of 1st, 2nd, and 3rd graders (N = 1,914-2,044).
Piecewise linear regression analyses and nonlinear regression modeling both demonstrated that the relationship between symptom severity (ADHD-RS-IV total score) and impairment (WFIRS-P mean score) was characterized by a gradual linear increase in impairment with higher symptom severity and no apparent step increase or changing rate of increase in impairment at a certain high ADHD-RS-IV total score level. Controlling for socioeconomic status, sex, and co-occurring conduct and emotional symptoms did not alter these results, though comorbid symptoms had a significant effect on impairment.
There was no clear evidence for a discrete, nonarbitrary symptom severity threshold with regard to impairment. The results highlight the continued need to consider both symptoms and impairment in the diagnosis of ADHD.
注意力缺陷多动障碍（ADHD）的诊断需要在特定频率和严重程度阈值之上存在症状，同时伴有损害。然而，这个症状阈值是否代表了损害连续体上的任何超出任意截止点的东西，需要进一步的实证研究。因此，我们提出了第一项研究，旨在调查 ADHD 症状严重程度和功能损害之间的关系是否是非线性的，这种关系是否暗示了与损害显著增加相关的离散、非任意的症状水平阈值。
在一年级、二年级和三年级的普通人群样本中（N=1914-2044），收集了 ADHD-Rating Scale（ADHD-RS-IV）、Weiss 功能损害评定量表（WFIRS-P）和 Strengths and Difficulties Questionnaire 的父母报告。
分段线性回归分析和非线性回归模型都表明，症状严重程度（ADHD-RS-IV 总分）和损害（WFIRS-P 平均分）之间的关系以损害的逐渐线性增加为特征，随着症状严重程度的增加而增加，在特定的 ADHD-RS-IV 总分水平上，损害没有明显的阶跃增加或增加率变化。控制社会经济地位、性别和共患的行为和情绪症状并没有改变这些结果，尽管共患症状对损害有显著影响。
没有明确的证据表明损害存在离散的、非任意的症状严重程度阈值。结果强调了在 ADHD 的诊断中需要同时考虑症状和损害。
