Screening for Attention Deficit/Hyperactivity Disorder in Community Mental Health Services for Children

Kim, Jae Won; Park, Ki Hong; Choi, Min Jeong

Abstract

OBJECTIVES
Developing mental health services and systems to identify children with Attention Deficit/Hyperactivity Disorder (ADHD) and providing early therapeutic interventions for them are important to prevent further impairments or disturbances associated with the disorder. The purpose of this study is to examine the clinical validities and efficiencies of Korean Child Behavior Checklist (K-CBCL) and Korean ADHD Rating Scale (K-ARS) for screening and identifying children with ADHD in community.
METHODS
Randomly selected 1st to 3rd graders of the two elementary schools (n=1668) in the City of Gunsan participated in the study. K-CBCL and K-ARS were used as screening instruments. Diagnoses were determined by clinical psychiatric interviews and confirmed by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K) using DSM-IV criteria.
RESULTS
The rate of inclusion above the T score of 60 with regard to the attention problems profile of K-CBCL was 4.5%. There was a significant correlation (p<.01) between parent and teacher reports of K-ARS, and the rate of inclusion was 2.5% when 90th percentile cut-off points were applied for both of the reports. Of the 46 subjects who underwent clinical psychiatric interviews, 33 (71.7%) were diagnosed as ADHD. The T score of 60 with regard to the attention problems profile of K-CBCL resulted in a reasonable level of sensitivity or positive predictive value in the diagnosis of ADHD. 90th percentile cut-off scores in both parent and teacher reports of K-ARS resulted in a high level of predictive value. The highest level of specificity and positive predictive value were computed when K-CBCL (T> or =60 in attention problems) and K-ARS (parent/teacher total> or =90th percentile) reports were combined.
CONCLUSION
These findings suggest that the K-CBCL and K-ARS together could serve as a rapid and useful screening instrument to identify children with ADHD in epidemiologic case definitions.