Waltereit Johanna, Schulte-Rüther Martin, Roessner Veit, Waltereit Robert
Department of Child and Adolescent Psychiatry, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
Department of Child and Adolescent Psychiatry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
Eur Child Adolesc Psychiatry. 2025 Feb;34(2):659-673. doi: 10.1007/s00787-024-02509-4. Epub 2024 Jul 24.
The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood is particularly challenging because retrospective confirmation of previous childhood ADHD is mandatory. Therefore, collecting valid diagnostic information about behavior at school is important. Primary school reports often contain descriptions of academic performance and social behaviors associated with ADHD criteria. Yet, there is no systematic approach available how to assess such reports quantitatively, and therefore, there is also no study on how valid such an approach could predict an ADHD diagnosis.
We examined primary school reports from Germany (ADHD: n = 1197, typically developing controls: n = 656) for semantic references to ICD-10/DSM-5 main and sub-criteria of ADHD. Descriptions were assessed on a quantitative scale (blinded clinical expert rating) for disorder-associated behaviors (symptoms scale) as well as for desired, adaptive behaviors (competencies scale) according to these criteria. The scores of these developed scales have been summarized to summary scores. Scores were analyzed using linear mixed models, and sensitivity and specificity were estimated using receiver operating characteristics (ROC).
Ratings showed highly significant differences between school reports of children with and without ADHD. For the summary scores, both symptoms and competencies scales showed high diagnostic accuracy (ROC area under the curve at least 0.96) with best discrimination when combining both into an integrated index (sensitivity and specificity > 0.97).
Our findings suggest that systematic quantitative analysis of primary school reports should be further explored to construct a valid instrument for retrospective assessment of childhood ADHD criteria to aid the diagnostic process in adolescents and adults.
青少年期及成年期注意缺陷多动障碍（ADHD）的诊断极具挑战性，因为必须对既往儿童期ADHD进行回顾性确认。因此，收集有关学校行为的有效诊断信息非常重要。小学报告中常包含与ADHD标准相关的学业成绩和社会行为描述。然而，目前尚无系统的方法可用于定量评估此类报告，因此也没有关于这种方法预测ADHD诊断有效性的研究。
我们检查了来自德国的小学报告（ADHD组：n = 1197，正常发育对照组：n = 656），以查找与ICD - 10/DSM - 5中ADHD主要及次要标准的语义关联。根据这些标准，对描述内容在定量量表上进行评估（由盲态临床专家评分），评估与障碍相关的行为（症状量表）以及期望的适应性行为（能力量表）。将这些制定量表的得分汇总为综合得分。使用线性混合模型分析得分，并使用受试者工作特征曲线（ROC）估计敏感性和特异性。
评分显示，ADHD儿童与非ADHD儿童的学校报告之间存在高度显著差异。对于综合得分，症状量表和能力量表均显示出较高的诊断准确性（曲线下面积至少为0.96），将两者合并为一个综合指数时区分效果最佳（敏感性和特异性> 0.97）。
我们的研究结果表明，应进一步探索对小学报告进行系统的定量分析，以构建一种有效的工具，用于回顾性评估儿童期ADHD标准，辅助青少年和成人的诊断过程。
