Symptoms versus impairment: the case for respecting DSM-IV's Criterion D.
Symptoms versus impairment: the case for respecting DSM-IV's Criterion D.
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DOI：
10.1177/1087054705283881
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发表时间：
2006-02-01
影响因子：
3
通讯作者：
Cunningham, Charles
中科院分区：
文献类型：
--
作者：
Gordon, Michael;Antshel, Kevin;Cunningham, Charles
主要根据症状报告诊断ADHD假设症状的数量/频率与对个体功能的损害密切相关。这种假定的联系鼓励更多的诊断精神疾病的诊断和统计手册（第4版）。风格的症状列表比定义明确，心理测量健全的评估损害。目前的研究在四个独立的，大规模的ADHD研究样本中反映每个结构的相关措施。症状和损害之间的平均相关性占不到10%的方差。症状从来没有预测超过25%的变异损害。当根据当前症状的测量形成ADHD组时，当添加基于标准的损伤测量时，样本量缩小了77%。症状和损伤的部分分离对诊断过程的决定、参与者纳入的研究标准、患病率估计、性别比例、治疗效果评估、服务提供和许多其他问题都有影响。
Diagnosing ADHD based primarily on symptom reports assumes that the number/frequency of symptoms is tied closely to the impairment imposed on an individual's functioning. That presumed linkage encourages diagnosis more by Diagnostic and Statistical Manual of Mental Disorders (4th ed.) style symptom lists than well-defined, psychometrically sound assessments of impairment. The current study correlated measures reflecting each construct in four separate, large-scale ADHD research samples. Average correlation between symptoms and impairment accounted for less than 10% of variance. Symptoms never predicted more than 25% of the variance in impairment. When an ADHD group was formed according to a measure of current symptoms, the sample size shrunk by 77% when a criterion-based measure of impairment was added. The partial unlinking of symptoms and impairment has implications for decisions about the diagnostic process, research criteria for participant inclusion, prevalence estimates, gender ratios, evaluation of treatment effects, service delivery, and many other issues.