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

Abstract

We tested the accuracy of 2 parent-report tools, the Pediatric Symptom Checklist (PSC-35) and Child Behavior Checklist (CBCL), to identify attention-deficit/hyperactivity disorder (ADHD) and distinguish complex (highly comorbid) cases in an urban, largely Latino pediatric practice. Spanish- and English-speaking parents of children aged 6 to 10 years completed a PSC-35 and CBCL at well visits. Those with CBCL Attention Problems Subscale (CBCL-APS) T scores ≥60 plus controls completed the diagnostic MINI-KID (Miniature International Neuropsychiatric Interview) for Children. Receiver operating characteristic (ROC) curves quantified accuracy of both scales to distinguish ADHD from non-ADHD, and complex from simple ADHD. Two hundred and nine children were screened, and 41 completed diagnostic interviews. Both the CBCL-APS and PSC Attention Scale (PSC-AS) accurately identified ADHD; the CBCL-APS performed best (AUROC = 0.837; AUROC = 0.728). The PSC Total and Internalizing Scores and the number of CBCL subscale elevations accurately distinguished complex from simple ADHD; the PSC Internalizing Score performed best (AUROC = 0.700; AUROC = 0.817; AUROC = 0.762).

Screening, Monitoring, and Referral to Treatment for Young Adolescents at an Urban School‐Based Health Center

“…32 Over the years, several authors have suggested that the PSC-ES and PSC-AS cutoff scores might not be sensitive for detecting ADHD and/or behavioral disorders and alternate cutoff criteria have been suggested. 21,[33][34][35][36] All of these studies are based on the results from the PSC-17-P and may not be equally translated to the youth-completed version. Furthermore, there are no studies that evaluate the cutoff scores, sensitivity, specificity, or positive predictive value of the PSC-17-Y.…”

“…34,39 • Re-administrating the PSC-17-Y at follow-up assessments is helpful as it provides objective evidence for changes over time. Literature suggests that the PSC global score and subscale scores could help track treatment progress and outcomes 4,35,36 ; however, further research is needed to confirm this before making it a standard of care in clinical practice. • Finally, this model is even more relevant to the overall welfare of adolescents during the COVID-19 pandemic, given the increased mental health needs of adolescents, especially in socioeconomically disadvantaged communities that have been disproportionately impacted.…”

2.26 Is Sports Participation Protective of Child Mental Health?

“…The data for this study was collected from well-child visits at the Pediatric Unit of the Massachusetts General Hospital Chelsea Healthcare Center (MGH Chelsea) in Chelsea, MA. 41 The clinic is located in Chelsea, MA, which is one of the most densely populated cities in the country and home to a significant immigrant population, particularly Spanish-speaking.…”

“…The number of CBCL subscale elevations has been utilized as a marker of general psychiatric impairment in prior literature. 41 We determined this to be a general yet robust measure of potential psychiatric problems in our sample.…”

“…A cutoff between 0-2 and 3+ subscale elevations has been found in a prior study of this data set to maintain a good balance between sensitivity and specificity for the CBCL to diagnose complex ADHD. 41 With these two in mind, we also decided to test a cutoff between 0-1 and 2+ subscale elevations. We organized our secondary outcome variables into groups who had T scores between 0-59 and 60-100.…”