Attention Deficit/Hyperactivity Disorder: Screening and Evaluation

Payal Gaba; Matthew Giordanengo

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Jun 1, 2019 Issue

FPIN's Help Desk Answers

Attention-Deficit/Hyperactivity Disorder: Screening and Evaluation

PAYAL GABA, MD, Kadlec Family Medicine Residency, Richland, Washington

MATTHEW GIORDANENGO, DO, Montana Family Medicine Residency, Billings, Montana

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.)

Enlarge Print

eTABLE A

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.

eTABLE A

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:

Chang LY, Wang MY, Tsai PS. Diagnostic accuracy of rating scales for attention-deficit/hyperactivity disorder: a meta-analysis. Pediatrics . 2016;137(3):e20152749.

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

Address correspondence to Payal Gaba, MD, at payal.gaba@kadlec.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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.

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