Screening with ADHD Self-Report accurate in girls

The ADHD Self-Report for Adolescents (ASRS-A) could be used as a screening tool in speciality treatment settings and seems to give better psychometric properties in girls than in boys. The screening cut-off correctly identified over 80% of girls with attention-deficit/hyperactive disorder (ADHD). The diagnostic cut-off increased the probability of an ADHD diagnosis with over 40 percentage points [1].

Although ADHD is more prevalent in boys than in girls, both sexes experience similar negative consequences of this condition [2,3]. Nonetheless, most studies have been performed in boys [4]. Early diagnosis is crucial and suitable screening and diagnostic tools to identify affected girls are therefore much needed [5].

Dr Águeda Fernández-Quintana (University of Uppsala, Sweden) presented the results of a study that aimed 1) to establish adequate clinical cut-off points of the ASRS-A total score for the detection and identification of ADHD in girls who were referred to Child and Adult Psychiatry (CAP) and 2) to analyse differences in psychometric properties and clinically utility of the ASRS-A by sex.

Enrolled were 67 girls aged 12-18 years (mean age 15.9 years) who were referred to CAP in Sweden. They were interviewed with the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS) and they completed the ASRS-A. The results were compared with a group of 44 boys of the same age (mean age 15.4 years) who were referred to the same department. According to K-SADS, 40.3% of girls met the diagnostic criteria for ADHD.

Mean ASRS-A score was 34.61 points. The balanced screening cut-off score of ≥30 yielded a sensitivity of 81.5%, specificity of 50.0%, and accuracy of 62.7%. The balanced diagnostic cut-off of ≥44 points showed a specificity of 92.5%, sensitivity of 51.9%, and accuracy of 76.1% (see Table). The outcomes in the sample of boys showed a prevalence of ADHD of 68.2%. Researchers indicated that further studies in larger samples are necessary to validate these findings.

Table: Diagnostic accuracy scores of 4 new sex-specific cut-off scores of the ASRS-A among girls referred to CAP [1]


CAP, Child and Psychiatry in Sweden; ASRS-A, ADHD Self-Report for Adolescents; AUC, area under the curve; PPV, positive predictive value; NPV, negative prediction value; LR+, positive likelihood value.

 

1. Fernandez-Quintana A, et al. Improving ADHD screening and diagnosis for girls: new cut-off scores for The World Health Organization ADHD Self-Report for Adolescents (ASRS-A). P.045. ECNP Congress 2020.
2. Nussbaum NL. J Atten Disord. 2012;16(2):87-100.
3. Halmøy A, et al. J Atten Disord. 2009;13(2):175-87.
4. Quinn PO & Madhoo M. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596.
5. Hamed AM, et al. Front Psychiatry. 2015;6:168.

Posted on 2 November 2020