Is ADHD Diagnosed in Accord With Diagnostic Criteria? Overdiagnosis and Influence of Client Gender on Diagnosis
Is ADHD Diagnosed in Accord With Diagnostic Criteria? Overdiagnosis and Influence of Client Gender on Diagnosis
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DOI：
10.1037/a0026582
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发表时间：
2012-02-01
影响因子：
5.9
通讯作者：
Schneider, Silvia
中科院分区：
文献类型：
--
作者：
Bruchmueller, Katrin;Margraf, Juergen;Schneider, Silvia
目的：ADHD的诊断存在一些尚未解决的问题。首先，一些研究表明存在潜在的过度诊断。其次，与一般人群中的男女比例（3：1）相比，接受ADHD治疗的男孩比女孩多得多（6-9：1）。我们假设这是因为治疗师不遵守精神疾病诊断和统计手册（第4版; DSM-IV）和国际疾病分类（第10次修订）; ICD-10）标准。相反，我们假设，根据代表性启发式，治疗师可能会诊断注意力缺陷多动障碍（ADHD），如果一个病人类似于他们的概念，一个典型的ADHD儿童，导致治疗师忽略某些排除标准。这可能导致过度诊断。此外，由于ADHD在男性中更常见，男孩可能被视为更典型的ADHD儿童，因此可能比女孩更容易接受ADHD诊断。方法：我们向1,000名儿童心理学家、精神科医生和社会工作者发送了一个案例，请他们给出一个诊断。有四个版本的小插曲：小插曲1（ADHD）符合所有DSM-IV/ICD-10 ADHD标准。小插曲2-4（非ADHD）包括几种ADHD症状，但表示不符合其他ADHD标准。因此，无法做出ADHD诊断。此外，每个小插曲的男孩和女孩版本都被创建。结果：在Vignettes 2-4（非ADHD）中，16.7%的治疗师诊断为ADHD。在这些小插曲的男孩版本中，治疗师诊断的ADHD比女孩小插曲多2倍。结论：治疗师不严格遵守诊断手册。我们的研究表明，ADHD的过度诊断发生在临床常规和患者的性别影响诊断相当大。彻底的诊断培训可能有助于治疗师避免这些偏见。
Objective: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6-9:1). We hypothesized that this occurs because therapists do not adhere to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and International Classification of Diseases (10th rev.; ICD-10) criteria. Instead, we hypothesized that, in accordance with the representativeness heuristic, therapists might diagnose attention-deficit/hyperactivity disorder (ADHD) if a patient resembles their concept of a prototypical ADHD child, leading therapists to overlook certain exclusion criteria. This may result in overdiagnosis. Furthermore, as ADHD is more frequent in males, a boy might be seen as a more prototypical ADHD child and might therefore receive an ADHD diagnosis more readily than a girl would. Method: We sent a case vignette to 1,000 child psychologists, psychiatrists, and social workers and asked them to give a diagnosis. Four versions of the vignette existed: Vignette 1 (ADHD) fulfilled all DSM-IV/ICD-10 criteria of ADHD. Vignettes 2-4 (non-ADHD) included several ADHD symptoms but stated other ADHD criteria were nonfulfilled. Therefore, an ADHD diagnosis could not be given. Furthermore, boy and girl versions of each vignette were created. Results: In Vignettes 2-4 (non-ADHD), 16.7% of therapists diagnosed ADHD. In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes. Conclusions: Therapists do not adhere strictly to diagnostic manuals. Our study suggests that overdiagnosis of ADHD occurs in clinical routine and that the patient's gender influences diagnosis considerably. Thorough diagnostic training might help therapists to avoid these biases.