title: How does a real-world child psychiatric clinic diagnose and treat attention deficit hyperactivity disorder?
abstract: OBJECTIVE
  To investigate child and adolescent psychiatrists' (CAPs) attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) diagnoses and treatments in real-world clinical practice.
  
  
  METHODS
  The medical records of 69 ADHD children (mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales (VADRSs), CAPs' diagnoses of ADHD and ODD, and CAPs' treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs' ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs' treatment recommendations against established ADHD and ODD guidelines.
  
  
  RESULTS
  Among 63 ADHD subjects, the majority of the subjects (92%) met full ADHD diagnostic criteria at least in one setting (parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings (parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found (95%CI: -0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these case-positives, which is considered as a fair agreement between CAPs and VADRSs (95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.
  
  
  CONCLUSIONS
  CAPs' ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD's most common comorbid condition - ODD - may be under-recognized.
authors.affiliation: Kumi Yuki, Peter S Jensen, REACH Institute, New York, NY 10018, United States.
authors.forename: Kumi
authors.initials: K
authors.lastname: Yuki
authors.affiliation: Kumi Yuki, Peter S Jensen, REACH Institute, New York, NY 10018, United States.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Bhagia
authors.affiliation: Kumi Yuki, Peter S Jensen, REACH Institute, New York, NY 10018, United States.
authors.forename: David
authors.initials: D
authors.lastname: Mrazek
authors.affiliation: Kumi Yuki, Peter S Jensen, REACH Institute, New York, NY 10018, United States.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Jensen
keywords: Attention deficit hyperactivity disorder; Clinical practice; Oppositional defiant disorder; Quality assessment; Vanderbilt attention deficit hyperactivity disorder Diagnostic Rating Scale