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Am Fam Physician. 2019;99(11):712

Author disclosure: No relevant financial affiliations.

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.)

TestStudiesParticipantsSensitivity (95% CI)Specificity (95% CI)Positive LRNegative LR
Child Behavior Checklist–Attention Problems Scale143,29677% (69% to 84%)73% (64% to 81%)2.90.3
Conners Parent Rating Scale–Revised short form459675% (64% to 84%)75% (64% to 84%)3.00.3
Conners Teacher Rating Scale–Revised short form573372% (63% to 79%)84% (69% to 93%)4.60.3
Conners Abbreviated Symptom Questionnaire597283% (59% to 95%)84% (68% to 93%)5.30.2
Vanderbilt ADHD Diagnostic Parent Rating Scale156080% (71% to 87%)75% (66% to 83%)3.20.3
Vanderbilt ADHD Diagnostic Teacher Rating Scale137069% (43% to 87%)84% (78% to 89%)4.30.4

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.

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 (https://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 https://www.fpin.org or email:  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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