Vanderbilt父母评定量表在注意缺陷多动障碍诊断中的应用

Diagnostic value of Vanderbilt ADHD Parent Rating Scale in attention deficit hyperactivity disorder

摘要:

目的：本研究探讨了Vanderbilt父母评定量表（VADPRS）在注意缺陷多动障碍（ADHD）中的诊断价值。方法：319名疑诊为ADHD的儿童由父母完成VADPRS，同时由专科医师根据美国精神病学会《精神障碍诊断和统计手册》第四版（DSM-Ⅳ）标准进行诊断，最终诊断ADHD患儿196名。ROC曲线分析VADPRS诊断注意缺陷和多动冲动的价值，并计算最佳诊断界值的各诊断评价指标。计算Kappa系数，分析VADPRS各条目与DSM-Ⅳ诊断标准中对应条目的一致性。结果：VADPRS诊断注意缺陷的ROC曲线下面积为0.791，最佳诊断界值时敏感性为0.83，特异性为0.63，阳性预测值为0.69，阴性预测值为0.79；VADPRS诊断多动冲动的ROC曲线下面积为0.855，最佳诊断界值时敏感性为0.82，特异性为0.76，阳性预测值为0.65，阴性预测值为0.88。根据本研究结果推算出此量表人群筛查时阴性预测值为0.99。对Vanderbilt父母评定量表各症状条目与DSM-Ⅳ标准对应症状进行一致性分析发现大部分条目Kappa值小于0.40，一致性较差。结论：VADPRS有较好的诊断价值，适用于人群筛查ADHD患者和临床协助诊断。但是量表结果受家长对于孩子行为的了解和认知影响，不能替代专业人员的访谈和判断。

Abstract:

OBJECTIVE: To study the value of the Vanderbilt ADHD Parent Rating Scale (VADPRS) in the diagnosis of attention deficit hyperactivity disorder (ADHD). METHODS: VADPRS were completed by parents of 319 children with suspected ADHD. The children were then evaluated by a specialist based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and 196 of them were diagnosed with ADHD. The value of VADPRS in the diagnosis of attention deficit and hyperactivity was evaluated using ROC curves. Diagnostic evaluation indexes at best operating point were calculated. Kappa values were calculated to explore the consistency of items in VADPRS and corresponding items in the DSM-IV criteria. RESULTS: The area under the ROC curve for the diagnosis of attention deficit by VADPRS was 0.791. At the best operating point, its sensitivity was 0.83, specificity was 0.63, positive predictive value was 0.69 and negative predictive value was 0.79. The area under the ROC curve for the diagnosis of hyperactivity by VADPRS was 0.855. At the best operating point, its sensitivity was 0.82, specificity was 0.76, positive predictive value was 0.65, and negative predictive value was 0.88. The negative predictive value of VADPRS in general population screen was 0.99, based on the results of this study. The consistency of items in the VADPRS and corresponding items in DSM-Ⅳ criteria was poor, with the Kappa value of most items being less than 0.40. CONCLUSIONS: VADPRS is suitable for a general population screen for ADHD and it is helpful in the clinical diagnosis of ADHD, but its results can be influenced by parents′ awareness and perception of children′s behavior, and cannot replace the interview and judgment of professionals.