title: Agreement Among Categorical, Dimensional, and Impairment Criteria for ADHD and Common Comorbidities.
abstract: To compare the results of categorically based versus dimensionally based scoring algorithms for a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-referenced teacher rating scale for assessing ADHD and commonly co-occurring conditions and to determine their relative agreement with ratings of symptom-induced impairment.
  
  
  
  Teachers completed Child and Adolescent Symptom Inventory-4R (CASI-4R) ratings for 1,092 youth (ages 6-18 years) referred to a child and adolescent psychiatry outpatient service. Caseness was determined according to DSM-IV symptom count (categorical model) and T-score (dimensional model) criteria.
  
  
  
  Agreement between symptom count and T-score cutoffs was generally good (kappa ≥ 0.61) for ADHD-Inattentive, ADHD-Hyperactive-Impulsive, ADHD-Combined (except adolescent females), Oppositional Defiant Disorder, and Conduct Disorder, but this was not the case for anxiety and depressive disorders where only 15% of kappas were good. Agreement of impairment cutoff with T-score and symptom count cutoffs ranged from poor to good.
  
  
  
  In general, although in many cases CASI-4R categorical and dimensional scoring algorithms generated similar results, there was considerable variability across disorders, age groups, scoring method, and in some cases, gender. Moreover, symptom counts and T-scores are not a proxy for assessing impairment suggesting that each scoring strategy likely provides unique information for clinical decision-making.
authors: Stony Brook University, NY, USA joyce.sprafkin@stonybrook.edu.
authors: Joyce
authors: J
authors: Sprafkin
authors: Temple University, Philadelphia, PA, USA.
authors: Elizabeth A
authors: EA
authors: Steinberg
authors: Stony Brook University, NY, USA.
authors: Kenneth D
authors: KD
authors: Gadow
authors: Temple University, Philadelphia, PA, USA.
authors: Deborah A G
authors: DA
authors: Drabick
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000175:diagnosis*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000150:complications / Q000175:diagnosis; D002648:Child; D019955:Conduct Disorder / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019263:Dysthymic Disorder / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D006948:Hyperkinesis / Q000150:complications / Q000175:diagnosis; D008297:Male; D012189:Retrospective Studies
keywords: ADHD; DSM-IV; functional impairment; rating scales
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