[The predictive value of DSM-IV criteria in the diagnosis of attention deficit hyperactivity disorder and its cultural differences].
BACKGROUND
The most common method used to diagnose attention deficit/hyperactivity disorder (ADHD) is based on the Diagnostic and statistic manual of mental disorders, 4th edition (DSM-IV) criteria. Nevertheless, it is more likely that the categorical system postulated by DSM-IV is not the most appropriate method as it does not consider the possible differences between the diagnostic capacity of the 18 proposed criteria. AIM. To analyze the predictive power of each DSM-IV diagnostic symptoms/criteria for ADHD using DuPaul's ADHD Parent and Teacher Rating Scales.


METHODS
In a prospective, poblational study to evaluate the prevalence of ADHD the positive predictive power of each item was analyzed for each subtype and informant. A kappa index was applied for positive predictive power to correct the number of accurate predictions based on chance factors, and a ranking of items was established to determinate which ones offered the highest predictive power, comparing parent and teacher ratings.


RESULTS
The results suggest that not all DSM-IV criteria are equal with regard to their ability to predict ADHD. The predictive power varies as a function of the informant. Parent and teachers agreed more on hyperactivity and impulsivity items, and showed more significant differences with regard to the American sample.


CONCLUSIONS
The approach that aggregates any combination of items will not be the more effective strategy for ruling in a diagnosis of ADHD. To improve the clinical value of these scales making item combinations is recommended, the ones that will have attached a higher clinical weight for ruling in a diagnosis of ADHD.
Cardo
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Universitat de les Illes Balears, 07071 Palma de Mallorca, Espana. ecardojalon@gmail.com
Bustillo
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Servera
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D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000208:ethnology*; D002648:Child; D003469:Culture; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005006:Ethnicity / Q000706:statistics & numerical data; D006801:Humans; D011237:Predictive Value of Tests; D015203:Reproducibility of Results