Screening for Attention-Deficit/Hyperactivity Disorder and Comorbidities in a Diverse, Urban Primary Care Setting

Area of Science:

• Child and Adolescent Psychiatry
• Pediatric Psychology
• Clinical Assessment Tools

Background:

• Accurate identification of attention-deficit/hyperactivity disorder (ADHD) is crucial in pediatric settings.
• Distinguishing complex, highly comorbid ADHD cases presents a clinical challenge.
• Parent-report screening tools are widely used but require validation for specific populations.

Purpose of the Study:

• To evaluate the accuracy of the Pediatric Symptom Checklist (PSC-35) and Child Behavior Checklist (CBCL) in identifying ADHD.
• To assess the ability of these tools to differentiate complex from simple ADHD presentations.
• To validate these measures in an urban, predominantly Latino pediatric practice.

Main Methods:

• A cross-sectional study involving parents of children aged 6-10 years in a pediatric practice.
• Administration of the PSC-35 and CBCL, followed by diagnostic interviews (MINI-KID) for a subset of children.
• Receiver operating characteristic (ROC) curve analysis to quantify the diagnostic accuracy of the scales.

Main Results:

• Both the CBCL Attention Problems Subscale (CBCL-APS) and PSC Attention Scale (PSC-AS) demonstrated accuracy in identifying ADHD.
• The CBCL-APS showed superior performance in ADHD identification (AUROC=0.837) compared to the PSC-AS (AUROC=0.728).
• The PSC Total and Internalizing Scores, along with CBCL subscale elevations, effectively distinguished complex from simple ADHD, with the PSC Internalizing Score performing best (AUROC=0.817).

Conclusions:

• The CBCL and PSC are valuable tools for screening ADHD in pediatric populations.
• The CBCL-APS is a highly accurate measure for ADHD identification.
• The PSC Internalizing Score shows promise for differentiating complex ADHD cases, aiding clinical decision-making.