Attention deficit hyperactivity disorder in adults.: Benchmarking diagnosis using the Wender-Reimherr adult rating scale
Attention deficit hyperactivity disorder in adults.: Benchmarking diagnosis using the Wender-Reimherr adult rating scale
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DOI：
10.1007/s00115-007-2375-0
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发表时间：
2008-03-01
期刊：
影响因子：
1.1
通讯作者：
Wender, P. H.
中科院分区：
文献类型：
--
作者：
Roesler, M.;Retz, W.;Wender, P. H.
我们报告了一项研究，比较不同的系统诊断注意缺陷多动障碍（ADHD）在成年期。招募了168名被转诊到我们的ADHD门诊部的患者进行评估。我们使用了精神疾病诊断和统计手册第四版。（DSM-IV），国际疾病分类第10版。（ICD-10）和犹他州诊断评估标准以及Wender犹他州评定量表、ADHD自我报告（ADHD-SR）和Wender Reimherr成人注意力缺陷障碍评定量表作为精神病理学评估工具。我们目前的基本心理测量数据的温德-赖姆赫尔访谈（WRI）。内部一致性确定为0.82（α）。评定者间关于ADHD诊断的信度为1.0（Kappa系数），ICC为0.98，指的是WRI总分。ADHD-SR的收敛效度为0.65（斯皮尔曼系数）。在168名患者中，有126名根据三个系统中的至少一个进行了ADHD诊断。DSM-IV诊断集导致119例ADHD诊断。与其他两个系统相比，这是ADHD诊断的最低水平。根据ICD-10诊断的所有87例ADHD均被DSM-IV覆盖。ICD-10没有独立的精神病理学项目，因此与DSM-IV相比，没有为诊断程序提供额外的分数。关于犹他州标准的情况是不同的。这些标准包括七个精神病理学领域：注意力不集中、多动、混乱、冲动、情感不稳定、过度反应和脾气暴躁。它们可以通过使用WRI进行评估。根据犹他州的概念，168名患者中有93名被诊断为ADHD，这比DSM-IV低得多。根据犹他州标准对该疾病的特定定义导致7名患者仅具有犹他州诊断，但没有DSM-IV诊断。因此，我们可以说，犹他州的标准对ADHD的诊断水平相对较高，但在某些情况下超越了DSM-IV。根据所有三种分类工具，56%的患者患有ADHD诊断。检查的因素结构的ADHD精神病理学代表的7个WRI和三个ADHD-SR分量表，我们发现一个双因素的解决方案解释了63%的方差。因子1被指定为冲动，情感不稳定，多动，和脾气暴躁;因子2包括注意力不集中，混乱，和过度反应。
We report on a study comparing different systems for the diagnosis of attention deficit hyperactivity disorder (ADHD) in adulthood. Recruited for evaluation were 168 patients referred to our ADHD outpatient unit. We used the Diagnostic and Statistical Manual of Mental Disorders 4th edn. (DSM-IV), International Classification of Diseases 10th edn. (ICD-10), and Utah criteria for diagnostic assessment and the Wender Utah rating scale, ADHD Self Report (ADHD-SR), and Wender Reimherr Adult Attention Deficit Disorder Rating Scale as psychopathological assessment tools. We present basic psychometric data of the Wender-Reimherr Interview (WRI). Internal consistency was determined as 0.82 (alpha). The inter-rater reliability was 1.0 (kappa coefficient) regarding ADHD diagnoses, and the ICC was 0.98 referring to the WRI total scores. The convergent validity with the ADHD-SR was 0.65 (Spearman coefficient). In 126 of 168 patients an ADHD diagnosis was made according to at least one of the three systems. The DSM-IV diagnostic set led to 119 ADHD diagnoses. As compared with the two other systems, this is about the minumum level for an ADHD diagnosis. All of the 87 ADHD diagnoses according to ICD-10 were covered by DSM-IV. The ICD-10 had no independent psychopathological items and therefore offered no additional points for the diagnostic procedure than the DSM-IV. The situation regarding Utah criteria is different. These criteria contain seven psychopathological domains: inattention, hyperactivity, disorganisation, impulsivity, affective lability, overreactivity, and hot temper. They can be assessed by use of the WRI. Ninety-three of 168 patients were diagnosed as having ADHD according to the Utah concept, which is much lower than with the DSM-IV. The particular definition of the disorder by the Utah criteria resulted in seven patients having only a Utah diagnosis but no DSM-IV diagnosis. Thus we are in a position to say that the Utah criteria have a relatively high level for making an ADHD diagnosis but in certain cases move beyond the DSM-IV. Of the patients 56% had ADHD diagnoses according to all three classification instruments. Examining the factor structure of the ADHD psychopathology represented by seven WRI and three ADHD-SR subscales, we found a two-factor solution explaining for 63% of the variance. Factor 1 was designated by impulsivity, affective lability, hyperactivity, and hot temper; factor 2 consisted of inattention, disorganisation, and overreactivity.