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A novel school-based approach to screening for attention deficit hyperactivity disorder

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Abstract

Current approaches to screening for ADHD result in high rates of false positives. A proof of concept study to investigate the added benefits in the school-based detection of ADHD of adding a standardised teacher to teacher interview to traditional parent and teacher report questionnaires. A school-based study of diagnostic accuracy of ADHD using a novel 2-stage screening process. Participants were all 1026 pupils enrolled in grades 1 to 6 (ages 6–12 years) of a school in Hunan Province, China. The primary outcome was a diagnosis of ADHD on the Kiddie Schedule for Affective Disorders and Schizophrenia Present Lifetime version. 230 (22.4%) of the 1026 students screened positive at Stage 1 (parent and teacher questionnaires) (Sensitivity 0.86 [95% CI, 0.75 to 0.96], specificity 0.80 [95% CI, 0.78–0.83], false positive rate 0.20 (95% CI, 0.18 to 0.23), false negative rate was 0.14 (95% CI, 0.12 to 0.16). 65 remained screen-positive at the Stage 2 screen (teacher to teacher SNAP-IV interview). 36/65 (55.4%) of these Stage 2 screen positive participants and 1/144 (0.7%) of the screen negative subjects met DSM-IV criteria for ADHD (sensitivity 0.83 [95% CI, 0.71–0.95]; specificity of 0.97 [95% CI, 0.96–0.98]; false positive rate 0.03 [95% CI, 0.01 to 0.04], false negative rate 0.16 [95% CI, 0.15 to 0.19]. Adding teacher to teacher interviews to traditional questionnaire-based screening has the potential to improve the clinical utility of school-based screening for ADHD reducing the proportion of false positives, without a negative impact on sensitivity.

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Availability of data and materials

Whilst participants gave permission for their data to be used for research, they did not consent to share this information publicly. This is in line with the recommendations by the Institutional Review Board and principle 9 of the Declaration of Helsinki. Thos seeking access to the data should apply jointly to Prof. David Coghill (david.coghill@unimelb.edu.au) and Professor Linyan Su (xysulinyan@126.com). Following application, consideration will be made for allowing access to a de-identified data file.

Abbreviations

ADHD:

Attention Deficit Hyperactivity Disorder

ARI:

Average rating per-item

CI:

Confidence interval

DSM-IV:

Diagnostic and statistical manual of mental disorders. 4th ed.

GP:

General practitioner

KSADS-PL:

Kiddie Schedule for Affective Disorders and Schizophrenia Present Lifetime version

NPV:

Negative predictive value

ODD:

Oppositional defiant disorder

PPV:

Positive predictive value

SNAP-IV:

Swanson Nolan and Pelham- IV ADHD rating scale

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Acknowledgements

Dr Fan Yang; Data collection, Dr Guangwen Huang; Study coordination with school, Mr Shun Au: UK/China study coordination, Prof. Eric Taylor: Comments on manuscript and editing first draft of manuscript.

Funding

Professor Coghill received funding as part of a research grant from Shire to support travel to China and accommodation whilst there. No other funding was received for study design, the collection, analysis, and interpretation of data, for the writing of the report or the decision to submit the article for publication. All researchers were fully independent from funders and had full access to all of the data. The researchers take responsibility for the integrity of the data and the accuracy of the data analysis.

Author information

Authors and Affiliations

  1. Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia

    David Coghill & Melissa Mulraney

  2. Murdoch Children’s Research Institute, Melbourne, Australia

    David Coghill & Melissa Mulraney

  3. School of Medicine, Shanghai Mental Health Center, Jiaotong University, Shanghai, China

    Yasong Du, Wenqing Jiang & Yun Qian

  4. Mental Health Institute of The Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, China

    Xian & Linyang Su

  5. Xiamen Xianyue Hospital, Xianyue, Fujian, China

    Dali Lu

Authors
  1. David Coghill
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  4. Xian
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  8. Linyang Su
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Contributions

DC: conceptualized and designed the study, designed and implemented the statistical plan, led the discussion and interpretation of results, drafted the initial manuscript, approved the final manuscript as submitted and is guarantor for the study. YD, LS: contributed to study design, discussion and interpretation of results, critical review and editing of manuscript drafts and approved the final manuscript as submitted. WG: was responsible for on-site study coordination, clinical assessments and data collection, discussion and interpretation of results, critical review and editing of manuscript drafts and approved the final manuscript as submitted. DL, QX: were involved in clinical assessments and data collection, discussion and interpretation of results, critical review and editing of manuscript drafts and approved the final manuscript as submitted. MM: was involved in analysis and interpretation of the results, critical review and editing of manuscript drafts. All authors read and approved the final manuscript.

Corresponding author

Correspondence to David Coghill.

Ethics declarations

Conflict o interests

All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author). None of the authors received and financial support for writing this article. David Coghill has received research support and/or honoraria from Shire/Takeda, Medice, Servier and Oxford University Press, Yasong Du has received research support and/or honoraria from Shire, Lilly, Janssen-Cilag and Linyang Su has received research support and/or honoraria from Shire, Lilly, Janssen-Cilag. None of the other authors have any financial disclosures relevant to this article. Other than the financial disclosures noted above none of the authors have conflicts of interest to disclose.

Consent to participate

All participants gave consent to participate.

Ethical standards

All procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human subjects/patients were approved by the ethical review board of the Second Xiangya Hospital of Central South University, Hunan, China (ref no. 2009 S170).

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Coghill, D., Du, Y., Jiang, W. et al. A novel school-based approach to screening for attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 31, 909–917 (2022). https://doi.org/10.1007/s00787-021-01721-w

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  • DOI: https://doi.org/10.1007/s00787-021-01721-w

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