Comparative Validity of DSM-IV and Alternative Empirically Derived Approaches for the Assessment of ADHD

To identify ADHD symptoms that are most highly predictive of ADHD diagnostic status and compare them against Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) algorithms in predictions of functional impairment.

Parent and teacher ratings of ADHD were obtained from an ethnically diverse (46% non-White) sample of 151 five- to ten-year-old children (27% female) with ( n = 76) and without ( n = 75) DSM-IV ADHD. We calculated total predictive values to estimate how ratings of each ADHD symptom predicted ADHD diagnostic status based on a structured parent diagnostic interview. Optimal symptom thresholds (i.e., not at all, just a little, pretty much, very much) for predicting ADHD caseness differed for inattention and hyperactivity and parents versus teachers. Algorithms consisting of highly predictive symptoms were then created and compared against DSM-IV-based algorithms to predict independent measures of functional impairment.

Several empirically derived symptom algorithms were more strongly associated with functional impairment than DSM-IV-based algorithms.

These preliminary findings suggest that alternative methods to aggregating ADHD symptoms may improve predictions of impairment.