Assessing ADHD symptoms in clinical public practice: Is a reliable final diagnosis possible? / Evaluando los síntomas del TDAH en la práctica clínica pública: ¿Es posible un diagnóstico final seguro?

Introduction: Attention deficit and hyperactivity disorder (ADHD) rates vary between 1% and 20% depending on the type of diagnosis guide used, the test used in the assessment, psychosocial factors, and professional in charge of the assessment. Goal: to describe and compare current clinical ADHD assessment processes in public health system in two cohorts and analyze variables related to final diagnosis. Design: Descriptive, multicenter, longitudinal (retrospective-prospective). Location: primary care (PC) centers in Oviedo, Asturias (Spain). Participants: a Spanish clinical ADHD symptomatic sample (n=134) from two cohorts (2004 and 2009). Variables: clinical professional in charge of ADHD assessment (PC, mental health professional [MH], neuropediatrician [NP]), type of test used in the assessment, confirmation/disconfirmation of ADHD diagnosis, and final diagnosis.Results: the use of symptoms checklists and the assessments in charge of primary care (PC) and neuropediatrician (NP) professionals show an upward trend from 2004 to 2009. ADHD final diagnosis shows low inter-professional (NP-MH) reliability (kappa=0.39). Final diagnoses for the same symptoms are different depending on the professional (NP or MH). Discussions: the professional in charge of the assessment appears to be a relevant variable for the final diagnosis. ADHD diagnosis criteria seem not to be clear. This data suggests that ADHD diagnosis must be used with caution to ensure good quality clinical standards when assessing and treating ADHD symptoms. Assessments supported by symptoms checklists and performed by NP or PC could be contributing factors to an ADHD over-diagnosis tendency.(AU)

Introducción: Las ratios del trastorno de déficit de atención e hiperactividad (TDAH) varían entre el 1 y el 20%, dependiendo del tipo de guía diagnóstica utilizada, del test usado en la evaluación, de los factores psicosociales y del profesional a cargo de la evaluación. Objetivo: Describir el proceso actual de evaluación del trastorno por déficit de atención e hiperactividad (TDAH) en la práctica clínica en el sistema público de salud y analizar las variables relacionadas con el diagnóstico final.Diseño: Estudio descriptivo y longitudinal (retrospectivo-prospectivo). Localización: Centros de atención primaria en Oviedo, Asturias (España). Participantes: Se analiza una muestra española de 134 casos clínicos en dos cohortes (2004 y 2009). Variables: Profesional a cargo de la evaluación, test empleados en la evaluación y diagnóstico final. Resultados: El empleo de listas de síntomas y las evaluaciones a cargo de profesionales de atención primaria (AP) y de neuropediatría (NP) muestran una tendencia al alza entre 2004 y 2009. El diagnóstico final de TDAH muestra una baja fiabilidad interprofesional (kappa = 0,39). Conclusiones: El profesional a cargo de la evaluación parece ser una variable relevante para establecer un diagnóstico final. Los criterios de diagnóstico de TDAH no parecen claros. Estos datos sugieren que el diagnóstico de TDAH debe usarse con precaución para garantizar una práctica clínica de calidad al evaluar y tratar los síntomas de TDAH. Las evaluaciones apoyadas por listas de síntomas y realizadas por NP o AP podrían ser factores que contribuyen a una tendencia de diagnóstico excesivo de TDAH.(AU)

Assessing ADHD symptoms in clinical public practice: Is a reliable final diagnosis possible?

INTRODUCTION: Attention deficit and hyperactivity disorder (ADHD) rates vary between 1% and 20% depending on the type of diagnosis guide used, the test used in the assessment, psychosocial factors, and professional in charge of the assessment. GOAL: to describe and compare current clinical ADHD assessment processes in public health system in two cohorts and analyze variables related to final diagnosis. DESIGN: Descriptive, multicenter, longitudinal (retrospective-prospective). LOCATION: primary care (PC) centers in Oviedo, Asturias (Spain). PARTICIPANTS: a Spanish clinical ADHD symptomatic sample (n=134) from two cohorts (2004 and 2009). VARIABLES: clinical professional in charge of ADHD assessment (PC, mental health professional [MH], neuropediatrician [NP]), type of test used in the assessment, confirmation/disconfirmation of ADHD diagnosis, and final diagnosis. RESULTS: the use of symptoms checklists and the assessments in charge of primary care (PC) and neuropediatrician (NP) professionals show an upward trend from 2004 to 2009. ADHD final diagnosis shows low inter-professional (NP-MH) reliability (kappa=0.39). Final diagnoses for the same symptoms are different depending on the professional (NP or MH). DISCUSSIONS: the professional in charge of the assessment appears to be a relevant variable for the final diagnosis. ADHD diagnosis criteria seem not to be clear. This data suggests that ADHD diagnosis must be used with caution to ensure good quality clinical standards when assessing and treating ADHD symptoms. Assessments supported by symptoms checklists and performed by NP or PC could be contributing factors to an ADHD over-diagnosis tendency.