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探索儿童神经精神医学中的远程诊断程序:通过有监督的机器学习来解决 ADHD 诊断和自闭症症状问题。

Exploring telediagnostic procedures in child neuropsychiatry: addressing ADHD diagnosis and autism symptoms through supervised machine learning.

机构信息

Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Via Don Luigi Monza, 20, Bosisio Parini, Lecco, Italy.

Department of Economics, Management and Statistics, University of Milano-Bicocca, Milan, Italy.

出版信息

Eur Child Adolesc Psychiatry. 2024 Jan;33(1):139-149. doi: 10.1007/s00787-023-02145-4. Epub 2023 Jan 25.

Abstract

Recently, there has been an increase in telemedicine applied to child neuropsychiatry, such as the use of online platforms to collect remotely case histories and demographic and behavioral information. In the present proof-of-concept study, we aimed to understand to what extent information parents and teachers provide through online questionnaires overlaps with clinicians' diagnostic conclusions on attention-deficit/hyperactivity disorder (ADHD). Moreover, we intended to explore a possible role that autism spectrum disorders (ASD) symptoms played in this process. We examined parent- and teacher-rated questionnaires collected remotely and an on-site evaluation of intelligence quotients from 342 subjects (18% females), aged 3-16 years, and referred for suspected ADHD. An easily interpretable machine learning model-decision tree (DT)-was built to simulate the clinical process of classifying ADHD/non-ADHD based on collected data. Then, we tested the DT model's predictive accuracy through a cross-validation approach. The DT classifier's performance was compared with those that other machine learning models achieved, such as random forest and support vector machines. Differences in ASD symptoms in the DT-identified classes were tested to address their role in performing a diagnostic error using the DT model. The DT identified the decision rules clinicians adopt to classify an ADHD diagnosis with an 82% accuracy rate. Regarding the cross-validation experiment, our DT model reached a predictive accuracy of 74% that was similar to those of other classification algorithms. The caregiver-reported ADHD core symptom severity proved the most discriminative information for clinicians during the diagnostic decision process. However, ASD symptoms were a confounding factor when ADHD severity had to be established. Telehealth procedures proved effective in obtaining an automated output regarding a diagnostic risk, reducing the time delay between symptom detection and diagnosis. However, this should not be considered an alternative to on-site procedures but rather as automated support for clinical practice, enabling clinicians to allocate further resources to the most complex cases.

摘要

最近,远程医疗在儿童神经精神病学中的应用有所增加,例如使用在线平台远程收集病历和人口统计学及行为信息。在本概念验证研究中,我们旨在了解家长和教师通过在线问卷提供的信息在多大程度上与临床医生对注意力缺陷多动障碍(ADHD)的诊断结论相重叠。此外,我们还旨在探索自闭症谱系障碍(ASD)症状在这一过程中可能发挥的作用。我们检查了从 342 名(18%为女性)年龄在 3 至 16 岁的疑似 ADHD 患者中远程收集的家长和教师评定问卷以及现场智商评估结果。构建了一个易于解释的机器学习模型——决策树(DT),以模拟基于收集数据对 ADHD/非 ADHD 进行分类的临床过程。然后,我们通过交叉验证方法测试 DT 模型的预测准确性。将 DT 分类器的性能与其他机器学习模型(如随机森林和支持向量机)的性能进行了比较。通过 DT 模型进行诊断错误的差异测试,以探讨 ASD 症状在其中的作用。DT 可以识别出临床医生用于对 ADHD 诊断进行分类的决策规则,其准确率为 82%。关于交叉验证实验,我们的 DT 模型达到了 74%的预测准确率,与其他分类算法相当。护理人员报告的 ADHD 核心症状严重程度是临床医生在诊断决策过程中最具区分力的信息。然而,当需要确定 ADHD 的严重程度时,ASD 症状是一个混杂因素。远程医疗程序可有效获取关于诊断风险的自动输出,减少从症状检测到诊断的时间延迟。然而,这不应被视为现场程序的替代方案,而应被视为临床实践的自动化支持,使临床医生能够将更多资源分配给最复杂的病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37d9/10806173/8ff1e505d20a/787_2023_2145_Fig1_HTML.jpg

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