诊断年轻人的注意力缺陷/多动障碍(ADHD):对评估措施的效用和改进诊断过程的建议的定性回顾

P. Marshall, J. Hoelzle, M. Nikolas
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引用次数: 33

摘要

摘要目的:确定增加临床访谈的评估方法,提高成人ADHD评估的诊断准确性。方法:对临床访谈、标准和新型ADHD行为评定量表、行为效度和症状效度测试、认知测试等诊断效果有限的研究文献进行回顾性分析。结果:基于本定性综述,单独的临床访谈和单独的ADHD行为评定量表在诊断ADHD方面具有足够的敏感性,但特异性较差。反应效度和症状效度测试在检测无效症状表现方面具有相当好的敏感性和非常好的特异性。认知测试在识别ADHD方面缺乏敏感性和特异性。将认知测试与行为评定量表结合使用,可显著提高评估组的特异性。执行功能行为评定量表和功能损害评定量表不太可能提高ADHD评估的诊断准确性。结论:基于这篇综述,推荐了关键的临床访谈问题、行为评定量表、症状效度测试和认知测试,这些测试有望加强当前的评估实践。这些是作者的个人观点,不是一致的标准,或任何组织颁布的指导方针。这些措施被纳入一个实用的,有些简略的,有可能提高临床医生诊断成人多动症的能力。
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Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process
Abstract Objective: Identify assessment measures that augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment. Method: The sometimes limited research literatures concerning the diagnostic efficacies of the clinical interview, standard and novel ADHD behavior rating scales, performance and symptom validity testing, and cognitive tests are critically reviewed. Results: Based on this qualitative review, both clinical interviews alone and ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD. Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation. Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD. Using cognitive tests in conjunction with behavior rating scales significantly improves the specificity of an assessment battery. Executive function behavior rating scales and functional impairment rating scales are unlikely to improve the diagnostic accuracy of ADHD assessment. Conclusions: Based on this review, key clinical interview questions, behavior rating scales, symptom validity tests, and cognitive tests that have promise to enhance current assessment practices are recommended. These are the authors’ personal opinions, not consensus standards, or guidelines promulgated by any organization. These measures are incorporated in a practical, somewhat abbreviated, battery that has the potential to improve clinicians’ ability to diagnose adult ADHD.
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