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Section 2.1: DSM 5 Diagnostic Criteria for ADHD
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
 * 1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
 * Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.
 * a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
 * b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
 * c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
 * d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
 * e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
 * f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
 * g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
 * h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
 * i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).


 * 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
 * Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.
 * a. Often fidgets with or taps hands or feet or squirms in seat.
 * b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
 * c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
 * d. Often unable to play or engage in leisure activities quietly.
 * e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
 * f. Often talks excessively.
 * g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
 * h. Often has difficulty waiting his or her turn (e.g., while waiting in line).
 * i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Additional Criteria
 * 1. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
 * 2. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
 * 3. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
 * 4. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
 * 5. Specify whether:
 * a. 314.01 (F90.2) Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.
 * b. 314.00 (F90.0) Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.
 * c. 314.01 (F90.1) Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.
 * 6. Specify if:
 * a. In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.
 * 7. Specify current severity:
 * a. Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning.
 * b. Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
 * c. Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

Areas Under the Curve (AUCs) and Likelihood Ratios for potential diagnostic and screening measures for child ADHD
TABLE/DATA FOR THE SAME INFO ON ADULT ADHD?? MISSING CLINICAL GENERALIZEABILITY LEVEL FOR MINI-KID

Note: All studies with one exception used structured or semi-structured clinical interviews to establish diagnosis of ADHD. The exception, the Sprafkin & Gadow study (2007), used a combination of CBCL rating scales, clinician review, and clinician consensus to confirm ADHD diagnosis. “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

Executive Summary

 * If, based on the evidence I collected, I had to choose one parent report, one teacher report, and one diagnostic interview upon which to base a diagnosis of child or adolescent ADHD, I would choose the following:
 * Parent Report Form: CBCL, specifically the CBCL Attention Problems Scale
 * Teacher Report Form: Conners Teacher Rating Scale Revised-Long Form (CTRSR-L), though it should be noted that there is not a lot of evidence that any teacher rating scale is really very effective in informing one's diagnosis of ADHD, and teacher report adds questionable incremental validity in terms of ADHD diagnosis over and above parent-report (Pelham, Fabiano, & Massetti, 2005; Shemmassian & Lee, 2011)
 * Diagnostic Interview: MINI-KID, though others are also acceptable.

Recommended Diagnostic Interviews:

 * MINI-KID : MINI-KID has good to excellent AUC values for most individual disorders, and good AUC values for ADHD diagnosis. MINI-KID also provides both positive and negative likelihood ratios that are helpful in determining changes in probability that clients has the disorder. Finally, the MINI-KID takes 68% less time (33 minutes versus 103 minutes) than the K-SADS-PL (Sheehan et. al, 2009).

Other recommended structured diagnostic interviews:

 * Diagnostic Interview Schedule for Children Version IV (DISC-IV; Jensen et al., 1996): Moderate to high test-retest reliability for the parent version (.79), adequate interrater reliability (0.70), demonstrated that children classified using the DISC had higher risk on indexes of child impairment, sensitive to behavioral and pharmacological treatment effects (Pelham et. al, 2005).
 * Diagnostic Interview for Children and Adolescents-Revised (DICA-R; Boyle et. al, 1993): High reliability scores for the parent version, parent assessment of ADHD tended to be more reliable for older children, stability of diagnosis demonstrated over 1 to 3 years. Good sensitivity and specificity of assessment and diagnosis reported (Pelham et al., 2005).

Other recommended semi-structured diagnostic interviews:

 * Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS; Biederman et al., 1993): Interrater reliability of К = .56, but demonstrated excellent convergence with CBCL Attention Problems Scale, used as the "gold-standard" against which numerous ADHD screening instruments and diagnostic interviews are compared (Pelham et al., 2005).

Recommended Screening Measures:

 * Parent Report:
 * CBCL Attention Problems Scale: The CBCL Attention Problems Subscale was the parent-reported subscale that had been analyzed using ROC methodology in multiple studies, resulting in AUC values ranging from 0.84-0.90. Those AUC values were the highest observed in my search of the literature. Additionally, in different studies the CBCL Attention Problems Scale produced LR+ values that ranged 6.92 to 47, which means they ranged from helpful to clinically decisive, though LR- ratios produced by the scale were less helpful (the lowest negative likelihood ratio value found was 0.19 and LR- values ranged from 0.19 to 0.66).
 * Other Recommended Measures:
 * Disruptive Behavior Disorder Rating Scale-Parent Report : Very similar results to CBCL. Slightly smaller AUC, (AUC = .78), and LR+ value (5.06), but more useful LR- value (0.20).
 * Teacher Report:
 * Conners Teacher Rating Scale Revised-Long Form (CTRS-R-L): There were no AUC values reported for the CTRS-R-L but the CTRS-R-L was the only scale to demonstrate a LR+ value (8.66) and a LR- value (0.24) that were both in the range of values that were clinically helpful.
 * Other (very tenatively) Recommended Measures:
 * TRF Attention Problems Subscale: No AUC value reported, somewhat clinically helpful LR+ value (LR+ = 3.66), not a clinically helpful LR- value (=0.73).