Attention deficit / hyperactivity disorder (ADHD), Is the presumptive diagnosis carried out in Paediatric Primary Care maintained in Child and Adolescent Mental Health Unit?
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https://doi.org/10.31766/revpsij.v34n1a2Keywords:
Attention deficit hyperactivity disorder, Diagnostic concordance, Mental health, Paediatric primary careAbstract
Introduction: ADHD is one of the most common neurodevelopmental disorders. Primary care (PC) pediatricians often receive patients who show cardinal symptoms of this entity.
Objective: To analyze the concordance between the presumptive diagnosis performed in PC and the definitive diagnosis of the Child and Adolescent Mental Health Unit (CAMHU).
Materials and methods: Prospective descriptive observational study in which 374 patients under 16 years were recruited from the CAMHU of Pontevedra health area during 2016. The Kappa index was analyzed globally and specific for the different diagnoses.
Results: 374 patients were included, 233 were referred with suspected ADHD, confirming the diagnosis in 102 patients. The global kappa concordance index is 0.29. For most diagnoses, agreement was weak. Concordance was good for Autism (0.61) and very good for Eating Disorder (1.00). For ADHD, the sensitivity was 95.33% (95% confidence interval (CI) 90.86-99.79), specificity 50.94% (CI95% 44.75-57.12), positive predictive value 43.78% (CI95% 37.19-50.36) and negative predictive value 96.45% (95% CI 93.05-99.86).
Conclusions: The concordance obtained between PC and CAMHU is low in our health area. The diagnostic concordace measured with the kappa index is weak for ADHD, however, it is good for both autism and eating disorders. The diagnostic validity for ADHD is moderate, with a high sensitivity and low specificity.
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