Clinical utility of new cut-off scores for the world health organization ADHD self-report scale among adolescents in psychiatric outpatient care

Previous analyses of the proposed cut-off score for the 18-item World Health Organization ADHD Self-Report Scale (ASRS-18) among psychiatrically referred adolescents have shown limited clinical utility. This prospective study examined the diagnostic accuracy and clinical utility of new cut-off scores of the ASRS-18 in a consecutive sample of 111 Swedish adolescent psychiatric outpatients. Using the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS) as the reference standard and based on predefined sensitivity and specificity criteria, multiple new general and sex-specific cut-off scores were evaluated. Results showed that clinical utility was greater for sex-specific cut-off scores than for general cut-off scores. The greatest change in pre-test to post-test probability of ADHD diagnosis was observed with a balanced, high-specificity diagnostic cut-off score for girls, where the probability of ADHD increased from 40% pre-test to 82% post-test. The proposed new cut-off levels for the ASRS-18 are useful for the detection and identification of ADHD among adolescents in general psychiatric outpatient settings. (AU)

Clinical utility of new cut-off scores for the world health organization ADHD self-report scale among adolescents in psychiatric outpatient care.

Previous analyses of the proposed cut-off score for the 18-item World Health Organization ADHD Self-Report Scale (ASRS-18) among psychiatrically referred adolescents have shown limited clinical utility. This prospective study examined the diagnostic accuracy and clinical utility of new cut-off scores of the ASRS-18 in a consecutive sample of 111 Swedish adolescent psychiatric outpatients. Using the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS) as the reference standard and based on predefined sensitivity and specificity criteria, multiple new general and sex-specific cut-off scores were evaluated. Results showed that clinical utility was greater for sex-specific cut-off scores than for general cut-off scores. The greatest change in pre-test to post-test probability of ADHD diagnosis was observed with a balanced, high-specificity diagnostic cut-off score for girls, where the probability of ADHD increased from 40% pre-test to 82% post-test. The proposed new cut-off levels for the ASRS-18 are useful for the detection and identification of ADHD among adolescents in general psychiatric outpatient settings.

Urgencias psiquiátricas infanto-juveniles: 7 años de seguimiento / A 7-year follow-up study of Child and Adolescent Mental Health Emergencies

INTRODUCCIÓN: A pesar de la mayor demanda de urgencias psiquiátricas infanto-juveniles, las características de este colectivo no han sido definidas con precisión. OBJETIVOS: Analizar variables clínicas y sociodemográficas de los menores de 17 años evaluados en Urgencias Psiquiátricas de un hospital general. Estudiar la adherencia terapéutica y la estabilidad diagnóstica tras la atención urgente. MÉTODO: Estudio retrospectivo en una muestra de 218 atenciones psiquiátricas infanto-juveniles durante 7 años (2010-2017). RESULTADOS: Edad media 13,60 años (DE: 2,36). Sexo: 54% mujeres, 46% varones. El número de atenciones psiquiátricas infanto-juveniles aumentó desde 11,6% en 2010 hasta 23,3% en 2016. Motivo de consulta más frecuente: alteraciones conductuales en varones y autolesiones en mujeres. Antecedentes de intento autolítico mujeres: 46,4%, varones: 14%. La mayoría de los pacientes presentaban antecedentes psiquiátricos personales y familiares. Antecedentes somáticos (17,1%), la enfermedad más prevalente fue la epilepsia (9,7%). El 11,5% consumían tóxicos (droga más frecuente: THC), el abuso de alcohol era más prevalente entre las mujeres. Tasa de hospitalización (14,7%), los pacientes más jóvenes precisaban ingreso con mayor frecuencia. En Urgencias se prescribieron psicofármacos en el 62,3% de los casos (grupo más recetado: antipsicóticos 38,9%). Derivación para seguimiento ambulatorio (72,5%), asistencia a la primera consulta (81%), retirada de prescripciones farmacológicas (58%). Estabilidad diagnostica: 77,8%. CONCLUSIONES: Existen importantes diferencias de género en las urgencias psiquiátricas infanto-juveniles. Se trata de un colectivo vulnerable, la mayoría de los pacientes tienen antecedentes psiquiátricos personales y familiares, con perfil socio-demográfico desfavorable. Es necesario mejorar la adherencia terapéutica tras la atención urgente

INTRODUCTION: Despite the upward trend in child and adolescent psychiatric emergencies, the characteristics of this population have not been accurately described. OBJECTIVES: To underpin the clinical and sociodemographic variables associated with minors assessed in the Emergency Department (ED) due to mental health concerns. To analyze the therapeutic compliance and diagnostic stability upon ED discharge. METHOD: A retrospective study was undertaken on a sample composed of 218 patients aged under 17 years old over a 7-year period (2010-2017). RESULTS: Mean age 13,60 years (SD: 2.36). 54% females, 46% males. An upward trend in ED visits was noted, increasing from 11,6% in 2010 to 23,3% in 2016. Most common causes for assessment: behavioral disturbances in males and self-harm in females. 46,4% of females and 14% of males had a history of suicide attempt. Somatic history was recorded in 17,1% of cases: epilepsy (9,7%), coeliac disease (4,6%), diabetes (4,1%). In the overall sample, 11,5% of patients presented with substance misuse (cannabis was the most prevalent drug of abuse). Females had a higher prevalence of alcohol misuse. 62,3% of cases received pharmacological treatment upon discharge from ED (antipsychotics 38,9%, benzodiazepines 34,3%). 81% of patients attended the first follow-up outpatient appointment whilst only 58% followed the prescribed treatment accurately. Inpatient admission rate: 14,7%. Diagnostic stability: 77,8%. CONCLUSIONS: Relevant gender differences are noted in child and adolescent mental health emergencies. Patients assessed in ED due to psychiatric crises represent a vulnerable population with an unfavorable sociodemographic profile and high prevalence of somatic and psychiatric history