Young Susan, Absoud Michael, Al-Attar Zainab, Ani Cornelius, Colley William, Cortese Samuele, Crame Jo, Gudjonsson Gisli, Hill Peter, Hollingdale Jack, Mukherjee Raja A S, Ozer Susan, Partridge Gavin, Smith Jade, Woodhouse Emma Louise, Lewis Alexandra
Independent Practice, Psychology Services Limited, London, UK.
Department of Psychology, Reykjavik University, Reykjavik, Iceland.
Neuropsychiatr Dis Treat. 2024 Dec 24;20:2603-2628. doi: 10.2147/NDT.S472923. eCollection 2024.
Around 5% of the children and teenagers worldwide are affected by Attention-Deficit/Hyperactivity Disorder [ADHD], making it a major public health concern. Recently, demand for assessments has substantially increased, putting strain on healthcare and waiting lists. There is concern that pressure to clear service bottlenecks is leading to variable quality and reliability of ADHD assessments in this population. The ADHD Assessment Quality Assurance Standard for Children and Teenagers [CAAQAS] aims to address this by proposing a quality framework for ADHD assessments in this population. CAAQAS is intended to complement formal training, provide support to clinicians, inform commissioners, and empower children, teenagers, and caregivers on what to expect from an assessment and assessment report. Our goal is to promote evidence-based high-quality assessments, improve diagnostic accuracy, and reduce the risks of overdiagnosis, misdiagnosis, and underdiagnosis. Seven key topics were identified by authors which guided the development of this expert consensus statement. It was agreed that a high-quality diagnostic assessment of ADHD in this population commences with advance preparation to facilitate engagement of the child or teenager and caregivers. The consensus agreed that the minimum/essential standards for assessing and diagnosing ADHD adopt a systematic approach from pre-assessment through assessment to post-diagnostic stage, enabling ADHD to be disentangled from differential diagnoses. The process applies multi-source information to inform an assessment of development history and early risk factors, history of physical, mental health and other neurodevelopmental conditions, family, educational, and social histories. Assessment of core ADHD symptoms should include specific developmentally appropriate examples of associated difficulties and impairments. Neuropsychiatric and physical comorbidities should be assessed and identified. Recommendations for report writing are intended to facilitate effective communication between ADHD specialists and other services, and we highlight the importance of linking the diagnosis to an appropriate post-diagnostic discussion. Further, we discuss core competencies required to conduct a diagnostic assessment of ADHD in children and teenagers.
全球约5%的儿童和青少年受注意力缺陷多动障碍（ADHD）影响，这使其成为一个重大的公共卫生问题。近来，评估需求大幅增加，给医疗保健系统和候诊名单带来压力。有人担心，消除服务瓶颈的压力正导致该人群ADHD评估的质量和可靠性参差不齐。《儿童和青少年ADHD评估质量保证标准》（CAAQAS）旨在通过为此类人群的ADHD评估提出一个质量框架来解决这一问题。CAAQAS旨在补充正规培训，为临床医生提供支持，告知委托方，并使儿童、青少年及其照顾者了解评估及评估报告的预期内容。我们的目标是促进基于证据的高质量评估，提高诊断准确性，并降低过度诊断、误诊和漏诊的风险。作者确定了七个关键主题，这些主题指导了本专家共识声明的制定。大家一致认为，对该人群进行高质量的ADHD诊断评估始于提前准备，以促进儿童或青少年及其照顾者的参与。共识认为，评估和诊断ADHD的最低/基本标准采用从评估前到评估再到诊断后阶段的系统方法，以便将ADHD与鉴别诊断区分开来。该过程应用多源信息来评估发育史和早期风险因素、身心健康及其他神经发育状况史、家庭、教育和社会史。对ADHD核心症状的评估应包括相关困难和损害的特定发育适当示例。应评估和识别神经精神及身体合并症。报告撰写建议旨在促进ADHD专家与其他服务之间的有效沟通，我们强调将诊断与适当的诊断后讨论相联系的重要性。此外，我们还讨论了对儿童和青少年进行ADHD诊断评估所需的核心能力。
