Bitsko Rebecca H, Holbrook Joseph R, Fisher Prudence W, Lipton Corey, van Wijngaarden Edwin, Augustine Erika F, Mink Jonathan W, Vierhile Amy, Piacentini John, Walkup John, Firchow Bradley, Ali Akilah R, Badgley Allison, Adams Heather R
Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute - Columbia University - Vagelos College of Physicians and Surgeons, New York, NY.
Evid Based Pract Child Adolesc Ment Health. 2023;9(2):231-244. doi: 10.1080/23794925.2023.2191352.
Effective methods to assess mental disorders in children are necessary for accurate prevalence estimates and to monitor prevalence over time. This study assessed updates of the tic disorder and attention-deficit/hyperactivity disorder (ADHD) modules of the Diagnostic Interview Schedule for Children, Version 5 (DISC-5) that reflect changes in diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (Fifth edition, DSM-5). The DISC-5 tic disorder and ADHD parent- and child-report modules were compared to expert clinical assessment for 100 children aged 6-17 years (40 with tic disorder alone, 17 with tic disorder and ADHD, 9 with ADHD alone, and 34 with neither) for validation. For the tic disorder module, parent-report had high (>90%) sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, while the youth-report had high specificity and PPV, moderate accuracy (81.4%), and lower sensitivity (69.8%) and NPV (67.3%). The ADHD module performed less well: parent-report had high NPV (91.4%), moderate sensitivity (80.8%), and lower specificity (71.6%), PPV (50.0%), and accuracy (74.0%); youth-report had moderate specificity (82.8%) and NPV (88.3%), and lower sensitivity (65.0%), PPV (54.2%), and accuracy (78.6%). Adding teacher-report of ADHD symptoms to DISC-5 parent-report of ADHD increased sensitivity (94.7%) and NPV (97.1%), but decreased specificity (64.2%), PPV (48.7%), and accuracy (72.2%). These findings support using the parent-report tic disorder module alone or in combination with the child report module in future research and epidemiologic studies; additional validation studies are warranted for the ADHD module.
有效的儿童精神障碍评估方法对于准确估计患病率以及长期监测患病率是必要的。本研究评估了儿童诊断访谈量表第5版(DISC - 5)中抽动障碍和注意力缺陷多动障碍(ADHD)模块的更新情况,这些更新反映了《精神疾病诊断与统计手册》(第五版,DSM - 5)中诊断标准的变化。将DISC - 5抽动障碍和ADHD的家长报告及儿童报告模块与100名6至17岁儿童(40名单纯抽动障碍、17名抽动障碍合并ADHD、9名单纯ADHD、34名两者皆无)的专家临床评估进行比较以进行验证。对于抽动障碍模块,家长报告具有高(>90%)敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确性,而青少年报告具有高特异性和PPV、中等准确性(81.4%)以及较低的敏感性(69.8%)和NPV(67.3%)。ADHD模块表现较差:家长报告具有高NPV(91.4%)、中等敏感性(80.8%)以及较低的特异性(71.6%)、PPV(50.0%)和准确性(74.0%);青少年报告具有中等特异性(82.8%)和NPV(88.3%),以及较低的敏感性(65.0%)、PPV(54.2%)和准确性(78.6%)。将ADHD症状的教师报告添加到DISC - 5 ADHD家长报告中可提高敏感性(94.7%)和NPV(97.1%),但会降低特异性(64.2%)、PPV(48.7%)和准确性(72.2%)。这些发现支持在未来研究和流行病学研究中单独使用家长报告的抽动障碍模块或与儿童报告模块联合使用;ADHD模块需要更多的验证研究。