Published online Mar 22, 2016. doi: 10.5498/wjp.v6.i1.118
Peer-review started: June 1, 2015
First decision: September 30, 2015
Revised: December 6, 2015
Accepted: December 18, 2015
Article in press: January 4, 2015
Published online: March 22, 2016
Processing time: 292 Days and 0.5 Hours
AIM: 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.
CONCLUSION: CAPs’ ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD’s most common comorbid condition - ODD - may be under-recognized.
Core tip: Given the concerns about possible attention deficit hyperactivity disorder (ADHD) over-diagnosis and over-treatment, within a newly diagnosed sample of consecutive ADHD patients, we examined the concurrent validity of child and adolescent psychiatrists’ (CAPs) ADHD and oppositional defiant disorder (ODD) diagnoses against the results from the Vanderbilt ADHD Diagnostic Rating Scales. We also evaluated CAPs’ ADHD and ODD treatment recommendations and discussed clinical implementations of the established treatment guidelines into CAPs’ practice. In our samples, CAPs diagnosed ADHD strongly agreeing with the rating scales, but given our results showing the relatively low prevalence rates of ODD diagnosis within ADHD, ODD may be under-recognized.