FPIN's Help Desk Answers
Attention-Deficit/Hyperactivity Disorder: Screening and Evaluation
Am Fam Physician. 2019 Jun 1;99(11):712.
Clinical Question
What are the best screening tools for the evaluation and diagnosis of attention-deficit/hyperactivity disorder (ADHD)?
Evidence-Based Answer
The Conners Abbreviated Symptom Questionnaire has the best combination of positive and negative likelihood ratios (eTable A). (Strength of Recommendation [SOR]: B, based on a meta-analysis of observational studies.) The Vanderbilt ADHD Diagnostic Teacher and Parent Rating Scales also have moderate sensitivity and specificity in elementary school–aged children. (SOR: B, based on a single cohort study.)
Diagnostic Accuracy of Tests for Attention-Deficit/Hyperactivity Disorder
| Test | Studies | Participants | Sensitivity (95% CI) | Specificity (95% CI) | Positive LR | Negative LR |
|---|---|---|---|---|---|---|
Child Behavior Checklist–Attention Problems Scale | 14 | 3,296 | 77% (69% to 84%) | 73% (64% to 81%) | 2.9 | 0.3 |
Conners Parent Rating Scale–Revised short form | 4 | 596 | 75% (64% to 84%) | 75% (64% to 84%) | 3.0 | 0.3 |
Conners Teacher Rating Scale–Revised short form | 5 | 733 | 72% (63% to 79%) | 84% (69% to 93%) | 4.6 | 0.3 |
Conners Abbreviated Symptom Questionnaire | 5 | 972 | 83% (59% to 95%) | 84% (68% to 93%) | 5.3 | 0.2 |
Vanderbilt ADHD Diagnostic Parent Rating Scale | 1 | 560 | 80% (71% to 87%) | 75% (66% to 83%) | 3.2 | 0.3 |
Vanderbilt ADHD Diagnostic Teacher Rating Scale | 1 | 370 | 69% (43% to 87%) | 84% (78% to 89%) | 4.3 | 0.4 |
ADHD = attention-deficit/hyperactivity disorder; LR = likelihood ratio.
Information from:
Bard DE, Wolraich ML, Neas B, Doffing M, Beck L. The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population. J Dev Behav Pediatr . 2013;34(2):72–82.
Chang LY, Wang MY, Tsai PS. Diagnostic accuracy of rating scales for attention-deficit/hyperactivity disorder: a meta-analysis. Pediatrics . 2016;137(3):e20152749.
Wolraich ML, Bard DE, Neas B, Doffing M, Beck L. The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic teacher rating scale in a community population. J Dev Behav Pediatr . 2013;34(2):83–93.
Diagnostic Accuracy of Tests for Attention-Deficit/Hyperactivity Disorder
| Test | Studies | Participants | Sensitivity (95% CI) | Specificity (95% CI) | Positive LR | Negative LR |
|---|---|---|---|---|---|---|
Child Behavior Checklist–Attention Problems Scale | 14 | 3,296 | 77% (69% to 84%) | 73% (64% to 81%) | 2.9 | 0.3 |
Conners Parent Rating Scale–Revised short form | 4 | 596 | 75% (64% to 84%) | 75% (64% to 84%) | 3.0 | 0.3 |
Conners Teacher Rating Scale–Revised short form | 5 | 733 | 72% (63% to 79%) | 84% (69% to 93%) | 4.6 | 0.3 |
Conners Abbreviated Symptom Questionnaire | 5 | 972 | 83% (59% to 95%) | 84% (68% to 93%) | 5.3 | 0.2 |
Vanderbilt ADHD Diagnostic Parent Rating Scale | 1 | 560 | 80% (71% to 87%) | 75% (66% to 83%) | 3.2 | 0.3 |
Vanderbilt ADHD Diagnostic Teacher Rating Scale | 1 | 370 | 69% (43% to 87%) | 84% (78% to 89%) | 4.3 | 0.4 |
ADHD = attention-deficit/hyperactivity disorder; LR = likelihood ratio.
Information from:
Bard DE, Wolraich ML, Neas B, Doffing M, Beck L. The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population. J Dev Behav Pediatr . 2013;34(2):72–82.
Chang LY, Wang MY, Tsai PS. Diagnostic accuracy of rating scales for attention-deficit/hyperactivity disorder: a meta-analysis. Pediatrics . 2016;137(3):e20152749.
Wolraich ML, Bard DE, Neas B, Doffing M, Beck L. The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic teacher rating scale in a community population. J Dev Behav Pediatr . 2013;34(2):83–93.
Evidence Summary
A 2016 meta-analysis of 25 cross-sectional, cohort, and case-control studies evaluated the accuracy of the Child Behavior Checklist–Attention Problem Scale (CBCL-AP) and three versions of the Conners Rating Scales–Revised (CRS-R) for diagnosing ADHD in children and adolescents three to 18 years of age.1 Patients had all three types of ADHD: predominantly hyperactive/impulsive, predominantly inattentive, and combined. In addition to the CBCL-AP (14 studies) and the three versions of the CRS-R, the Conners Parent Rating Scale–Revised short form (four studies), the Conners Teacher Rating Scale–Revised short form (five studies), and the Conners Abbreviated Symptom Questionnaire (five studies) were evaluated. The reference standard was a clinical examination performed by a qualified professional using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM), 3rd or 4th ed., and corresponding diagnosis codes from the International Classification of Diseases, 9th or 10th revision. All scales had moderate sensitivity, specificity, and positive and negative likelihood ratios for diagnosing ADHD. The Conners Abbreviated Symptom Questionnaire may be the most effective diagnostic tool for ADHD because of its brevity and high diagnostic accuracy, and the CBCL-AP could be used for more comprehensive assessments.
A 2013 cohort study compared the Vanderbilt ADHD Diagnostic Parent/Teacher Rating Scales with a structured diagnostic psychiatric interview using DSM-IV criteria.2,3 Participants were selected from a random sample of elementary school students in urban, suburban, and rural school districts in Oklahoma. The Vanderbilt parent and teacher scales were moderately sensitive and specific for diagnosing ADHD.
Copyright © Family Physicians Inquiries Network. Used with permission.
References
1. Chang LY, Wang MY, Tsai PS. Diagnostic accuracy of rating scales for attention-deficit/hyperactivity disorder: a meta-analysis. Pediatrics. 2016;137(3):e20152749.
2. Bard DE, Wolraich ML, Neas B, Doffing M, Beck L. The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population. J Dev Behav Pediatr. 2013;34(2):72–82.
3. Wolraich ML, Bard DE, Neas B, Doffing M, Beck L. The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic teacher rating scale in a community population. J Dev Behav Pediatr. 2013;34(2):83–93.
Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).
The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.
This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.
A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.
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