Reformulating attention-deficit/hyperactivity disorder according to signal detection theory.
OBJECTIVE
The current diagnostic algorithm for attention-deficit/hyperactivity disorder (ADHD) is not highly predictive of impairment and yields low interrater agreement. The objective of this study was to enhance the diagnostic accuracy of ADHD by identifying the symptoms that are associated with impairment.


METHODS
Semistructured interviews and impairment rating scales were administered to parents and teachers of 218 children. Combinations of ADHD symptoms were examined according to a receiver operating characteristic (ROC) based procedure to create diagnostic algorithms that predict impairment.


RESULTS
In comparison with the DSM-IV, the ROC-based algorithms were 2 to 3 times more efficient in discriminating impaired from nonimpaired children. Parent and teacher agreement was also 3 times higher.


CONCLUSIONS
Limiting the diagnosis to symptoms that predict impairment can increase the validity of the ADHD diagnosis. Results also support the use of ROC analyses in developing better diagnostic algorithms.
Mota
V L
VL
Department of Psychiatry, Hospital for Sick Children, Toronto, Canada. russell.schachar@sickkids.on.ca
Schachar
R J
RJ
D000465:Algorithms; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012720:Severity of Illness Index; D017603:Signal Detection, Psychological