title: Attention-deficit hyperactivity disorder: agreement between clinical impression and the SNAP-IV screening tool.
abstract: BACKGROUND
  The CONCOR study aimed to determine the predictive value of the SNAP-IV screening tool for ADHD relative to the pediatricians' clinical global impression of the presence of ADHD in children attending their practice.
  
  
  METHODS
  In this multicentre, cross-sectional, case-control study participated pediatricians from all over Spain and each pediatrician enrolled at least six children over the age of 6 years who had no previous diagnosis of ADHD, three whom they considered to have symptoms characteristic of ADHD (DSM-IV criteria) and three children who did not. Screening with the SNAP-IV tool was completed by parents in the waiting room prior to a consultation (for any reason) and results were compared with the pediatrician's clinical global impression.
  
  
  RESULTS
  Results for 7263 Spanish children (>6 years of age) showed 'good' concordance between the SNAP-IV screening tool and the pediatricians' clinical impression of ADHD (kappa concordance index 0.6471; 95% confidence intervals: 0.6296-0.6646), with acceptable sensitivity and specificity (82.3% and 82.4%, respectively). Based on an estimated ADHD prevalence of 3-10%, the negative predictive values of SNAP-IV were 97.7%-99.3% and positive predictive values were 12.6-34.2%.
  
  
  CONCLUSIONS
  SNAP-IV is a useful screening tool that identifies children who are unlikely to have ADHD, and brings those in whom there is a high possibility of ADHD to the attention of the pediatrician for clinical evaluation.
authors.affiliation: Department of Psychiatry and Children and Adolescent Psychology, ADHD Unit, Hospital Sant Joan de Déu, Barcelona, Spain. jalda@hsjdbcn.org
authors.forename: José A
authors.initials: JA
authors.lastname: Alda
authors.forename: Eduardo
authors.initials: E
authors.lastname: Serrano-Troncoso
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008875:Middle Aged; D011570:Psychiatry; D011795:Surveys and Questionnaires