Validez del diagnóstico de trastorno por déficit de atención e hiperactividad frente trastorno hipercinéticoestudio comparativo del funcionamiento ejecutivo, emocional, y funcional

Abstract

Objectives: This study seeks to determine the validity of attention deficit hyperactivity disorder (ADHD) diagnoses in referrals from Primary Care (PC) based on the criteria applied at the Child and Adolescent Mental Health Center (CSMIJ), DSM- 5 or ICD-10. It also examines whether meeting the criteria for a certain clinical presentation is associated with differences in executive functioning, emotional regulation-expression, and functional impairment. This study also explored whether the differences found allow us to discriminate between the different clinical presentations. Methodology: A cross-sectional study was designed to compare ADHD diagnoses from PC referrals with the definitive ones issued in the CSMIJ, using DSM-5 and ICD-10 criteria. Validity indices were calculated, with 95% confidence intervals. Afterwards, a cross-sectional, descriptive, differential, multivariable and multigroup research study was designed. Parents/guardians of patients diagnosed with ADHD according to DSM-5 completed the measurement instruments: the Behavioral Assessment of Executive Function Questionnaire (BRIEF), the Strengths and Difficulties Questionnaire (SDQ), the Children's Emotional Expression Scale (EESC), and the Weiss Functional Impairment Rating Scale (WFIRS). The variables of the measurement instruments in patients with ADHD were compared according to whether they had ADHD-I or ADHD-C, and whether or not they met the criteria for HKD. The significance level chosen was 0.05. Cohen's d was used for the effect size. Binary logistic regression analyses were performed to determine the predictive capacity in the classification of patients based on the measured variables; an area under the curve (AUC) value ≥ 0.80 indicated good predictive capacity. Results: 315 patients were studied. One hundred and three met the criteria for ADHD according to DSM-5 and of them, 54 also met criteria for HKD according to ICD-10. The diagnosis of ADHD in the referrals presented a Sensitivity of 94.17% (95% CI: 89.65% - 98.70%), and a Specificity of 86.32% (95% CI: 81.70% - 90.95%) when applying DSM-5 criteria in the CSMIJ. The Sensitivity was 94.44% (95% CI: 87.41% - 100%), and the Specificity was 71.26% (95% CI: 65.58% - 76.95%) when applying ICD-10 criteria. Differences were found between ADHD-C and ADHD-I, in the General Index of Executive Function (p < 0.001, TE = -0.786), in emotional dysregulation (SDQ-DP15) (p < 0.001, TE = -1.08669) and in the total scores of the EESC questionnaire (p < 0.001, TE = -0.790) and the WFIRS questionnaire (p < 0.001, TE = -0.684), with higher scores in ADHD-C. No differences were found in whether or not they met HKD criteria. The regression analyzes developed to discriminate between ADHD-I and ADHD-C presented an AUC of 0.8456 (95% CI: 0.7676 - 0.9236) in executive functioning, 0.8088 (95% CI: 0.7243 - 0.8934) in emotional dysregulation, 0.7353 (CI 95%: 0.6429 - 0.8277) in emotional expression and 0.6691 (95% CI: 0.5718 - 0.7664) in functional impairment. To discriminate based on meeting or not meeting HKD criteria, the AUC were 0.5913 (95% CI: 0.4953 - 0.6872) in executive functioning, 0.6395 (95% CI: 0.5458 - 0.7331) in emotional dysregulation, 0.5180 (95% CI: 0.4237 - 0.6122) in emotional expression and 0.6960 (95% CI: 0.6067 - 0.7852) in functional impairment. Conclusions: The validity of the ADHD diagnosis in referrals from PC is high when applying DSM-5 criteria and moderate when applying ICD-10 criteria. ADHD-C patients have presented with more deterioration in all the measurement instruments used than do ADHD-I patients, but only executive functioning and emotional dysregulation have made it possible to discriminate between the two. No differences have been found in whether or not the criteria for THK are met, not allowing for discrimination between the two.