¿Cuál es la combinación de síntomas según padres y maestros más fiable para el diagnóstico de TDAH? / What combination of symptoms according to parents and teachers would be more reliable for the diagnosis of ADHD?

Introducción: El método politético, recogido en el Manual Diagnóstico y Estadístico de los Trastornos Mentales-IV, es el que se plantea tradicionalmente para el diagnóstico de los trastornos por déficit de atención e hiperactividad (TDAH). Sin embargo, es probable que este procedimiento, que conlleva establecer cualquier combinación de 6 ítems, no sea el más adecuado para establecer un diagnóstico de TDAH y que las diferentes combinaciones de ítems tengan desigual peso. Objetivo: Determinar qué combinaciones de ítems de las escalas de inatención e hiperactividad-impulsividad de DuPaul, para padres y maestros, son las más efectivas a la hora de diagnosticar o descartar un TDAH. Resultados: No todas las combinaciones de ítems de padres y maestros obtuvieron el mismo valor predictivo. Todas ellas ofrecieron altos grados de especificidad, pero bajos grados de sensibilidad; es decir, las combinaciones resultaron más efectivas y confiables para descartar este tipo de trastornos que a la hora de diagnosticarlos. Discusión: El método que implica establecer combinaciones de los ítems mejores predictores del TDAH ofreció superiores resultados que los del método politético. No obstante, se requieren futuros estudios con muestras que posean tasas base más elevadas para obtener datos más fiables. Asimismo, sería conveniente emplear un método alternativo para la selección de los sujetos participantes que permita comprobar, posteriormente, la eficacia diagnóstica pura de los diferentes ítems de las escalas de clasificación de los TDAH (AU)

Introduction: The polythetic method used in the DSM is the one proposed traditionally for the diagnosis of Attention Disorders with or without Hyperactivity (ADHD). However, it is possible that the approach which aggregates any combination of 6 items won’t be the optimal method to establish a diagnosis of ADHD, and that the different combinations may not be the same as regards to their ability to predict ADHD. Aim: Determine which combinations of items of DuPaul's inattention and hyperactivity-impulsivity scales (from parent and teacher versions), are the most effective to predict or rule out a diagnosis of ADHD. Results: Not every combination of items from parents and teachers obtained the same predictive value. All of them offered high levels of specificity, but had low sensivity; that is to say, the combinations were more effective and reliable for ruling out the disorder than predicting it. Conclusions: Data show that not every combination of ADHD items has the same predictive value and, therefore, the well-known polythetic method is disputable. The highest predictive value combinations, limitations of the study, and future lines of investigation are analyzed (AU)

[What combination of symptoms according to parents and teachers would be more reliable for the diagnosis of ADHD?]. / ¿Cuál es la combinación de síntomas según padres y maestros más fiable para el diagnóstico de TDAH?

INTRODUCTION: The polythetic method used in the DSM is the one proposed traditionally for the diagnosis of Attention Disorders with or without Hyperactivity (ADHD). However, it is possible that the approach which aggregates any combination of 6 items won't be the optimal method to establish a diagnosis of ADHD, and that the different combinations may not be the same as regards to their ability to predict ADHD. AIM: Determine which combinations of items of DuPaul's inattention and hyperactivity-impulsivity scales (from parent and teacher versions), are the most effective to predict or rule out a diagnosis of ADHD. RESULTS: Not every combination of items from parents and teachers obtained the same predictive value. All of them offered high levels of specificity, but had low sensivity; that is to say, the combinations were more effective and reliable for ruling out the disorder than predicting it. CONCLUSIONS: Data show that not every combination of ADHD items has the same predictive value and, therefore, the well-known polythetic method is disputable. The highest predictive value combinations, limitations of the study, and future lines of investigation are analyzed.

[Oppositional defiant disorder: aspects related to sex differences and informant]. / Trastorno negativista desafiante: aspectos relacionados con el sexo y el evaluador.

INTRODUCTION: Oppositional defiant disorder (ODD) is one of the most common externalizing disorders in childhood. ODD prevalence global rates vary from 2% to 16%. Along with conduct disorder and attention deficit disorder, ODD is one of the leading reasons for referral to neuropediatric and psychiatric services. Even though ODD has recognized clinical importance, key aspects of its conceptualization and prevalence in childhood and adolescence remain uncertain. DEVELOPMENT: We examine previous research findings of ODD prevalence and analyze sex differences and differences according to informants. CONCLUSIONS: ODD prevalence rates present high variability. A number of studies suggest that ODD is more common in boys than in girls. Nevertheless, some authors point that this sex differences may be due to methodological bias. We recommend the validation of an ODD scale that has into consideration the following aspects: level of the subject's development (age), gender and environment.

Trastorno negativista desafiante: aspectos relacionados con el sexo y el evaluador / Oppositional deflant disorder: aspects related to sex differences and informant

Introducción. El trastorno negativista desafiante (TND) es uno de los trastornos externalizantes más prevalentes, con una tasa global del 2-16%. El TND, junto con el déficit de atención/hiperactividad y el trastorno de conducta, es una de las causas principales de derivación a los servicios especializados de neuropediatría y psiquiatría infantil. Aunque el trastorno tiene una relevancia clínica considerable, existe cierta incertidumbre con relación a los aspectos clave de su conceptualización y prevalencia tanto en la niñez como en la adolescencia. Desarrollo. Se revisan los estudios realizados sobre la prevalencia del TND y se analizan los aspectos relacionados con las diferencias según el sexo y en función del evaluador, debido a que en la actualidad los datos disponibles con relación a estos factores son escasos e inconsistentes. Conclusiones. Los índices de prevalencia del TND presentan una gran variabilidad dependiendo de la metodología utilizada y del evaluador (padres frente a maestros). La mayoría de estudios sugieren que el TND es más común en niños que en niñas, aunque algunos autores señalan que esto puede deberse a ciertos sesgos metodológicos. Se propone validar una escala de TND que tenga en cuenta el nivel de desarrollo del sujeto (edad), sexo y ambiente (AU)

Introduction. Oppositional defiant disorder (ODD) is one of the most common externalizing disorders in childhood. ODD prevalence global rates vary from 2% to 16%. Along with conduct disorder and attention deficit disorder, ODD is one of the leading reasons for referral to neuropediatric and psychiatric services. Even though ODD has recognized clinical importance, key aspects of its conceptualization and prevalence in childhood and adolescence remain uncertain. Development. We examine previous research findings of ODD prevalence and analyze sex differences and differences according to informants. Conclusions. ODD prevalence rates present high variability. A number of studies suggest that ODD is more common in boys than in girls. Nevertheless, some authors point that this sex differences may be due to methodological bias. We recommend the validation of an ODD scale that has into consideration the following aspects: level of the subject’s development (age), gender and environment. (AU)