Chamorro Yaira, Bolaños Lourdes, Trejo Salvador, Barrios Omar, Ramírez-Dueñas María de Lourdes, Alvarez-Tostado Pablo, Cervantes Alan, Matute Esmeralda
Instituto de Neurociencias, Centro Universitario de Ciencias Biológicas y Agropecuarias, Universidad de Guadalajara, Guadalajara, México.
Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, México.
Neuropsychiatr Dis Treat. 2021 Jun 16;17:1965-1975. doi: 10.2147/NDT.S308051. eCollection 2021.
BACKGROUND AND OBJECTIVE: Collecting information from different raters is important for diagnosing ADHD, but several factors can lead to gathering discrepant information. Our aim was to determine the agreement between parent and teacher's when rating the list of ADHD symptoms (criterion A, DSM-IV) in a sample of Mexican school-age children. We explored whether inter-rater agreement varied by children's age and sex, and each symptom of inattention, hyperactivity, and impulsivity. METHODS: A total of 789 children (335 girls) from six elementary school grades grouped as G1 [grades 1-2], G2 [grades 3-4], and G3 [grades 5-6]) were rated by their parents and teachers. We identified inter-rater reliability by using Cohen's kappa coefficient by school level, sex, and ADHD symptoms. We explored the presence of symptoms considering parents' and teachers' ratings, individually and collapsed, using the AND/OR rules. RESULTS: Low inter-rater agreement was observed. Moderate levels were observed in G1, but not in G2 or G3. Both groups of informants reported that more boys than girls met these criteria, but agreement by sex was still low, as were the results of the analyses by individual symptoms. Among the children that met the ADHD criteria, an inattention symptom was the one most frequently reported by both raters, whereas among non-ADHD children, a hyperactive symptom was the one most often reported. DISCUSSION: The exclusive use of questionnaires fails to provide convergent information between raters. We highlight the importance of conducting comprehensive clinical histories when diagnosing ADHD in order to explore what these discrepancies show about the relationship symptoms/context.
背景与目的:从不同评估者处收集信息对于多动症(ADHD)的诊断很重要,但有几个因素可能导致收集到不一致的信息。我们的目的是确定在一组墨西哥学龄儿童样本中,家长和教师对ADHD症状清单(《精神疾病诊断与统计手册》第四版标准A)进行评分时的一致性。我们探讨了评估者间的一致性是否因儿童的年龄和性别以及注意力不集中、多动和冲动的每种症状而有所不同。 方法:来自六个小学年级(分为G1[1 - 2年级]、G2[3 - 4年级]和G3[5 - 6年级])的789名儿童(335名女孩)由其家长和教师进行评分。我们通过学校级别、性别和ADHD症状,使用科恩kappa系数确定评估者间的可靠性。我们使用“与/或”规则,分别并综合考虑家长和教师的评分,探讨症状的存在情况。 结果:观察到评估者间的一致性较低。在G1中观察到中等水平,但在G2或G3中未观察到。两组信息提供者都报告称,达到这些标准的男孩比女孩多,但按性别划分的一致性仍然较低,按个体症状分析的结果也是如此。在符合ADHD标准的儿童中,注意力不集中症状是两位评估者最常报告的症状,而在非ADHD儿童中,多动症状是最常报告的症状。 讨论:仅使用问卷无法在评估者之间提供趋同的信息。我们强调在诊断ADHD时进行全面临床病史调查的重要性,以便探究这些差异所显示的症状/背景关系。
Neuropsychiatr Dis Treat. 2021-6-16
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