Table 6, KQ1 summary of findings and strength of evidence for clinician tools - ADHD Diagnosis and Treatment in Children and Adolescents

KQ1 Diagnostic Test	Outcome	Number of Studies and IDs	Findings	Reasons for Downgrading	SoE
KQ1 Clinician tool	Sensitivity	14 studies²⁷^, ¹²¹^, ¹⁶⁷^, ¹⁸¹^, ²⁹⁸^, ²⁹⁹^, ³⁵⁵^, ³⁸⁸^, ⁴⁰⁰^, ⁴⁰³^, ⁴⁰⁷^, ⁴¹⁶^, ⁴¹⁷^, ⁴³⁴	Sensitivity ranged from 25 (corresponding specificity 94%) using actigraph measures taken during CPT task⁴¹⁷ to 100% (corresponding specificity 99%) using extended activity measurement³⁵⁵ differentiating ADHD and neurotypical development Sensitivity ranged from 63% (corresponding specificity 74%) using a combination of medical record indicators⁴³⁴ to 93% using smart chair data¹⁸¹ in a clinical sample	C, I	Low
KQ1 Clinician tool	Specificity	14 studies²⁷^, ¹²¹^, ¹⁶⁷^, ¹⁸¹^, ²⁹⁸^, ²⁹⁹^, ³⁵⁵^, ³⁸⁸^, ⁴⁰⁰^, ⁴⁰³^, ⁴⁰⁷^, ⁴¹⁶^, ⁴¹⁷^, ⁴³⁴	Specificity ranged from 79% using an observational assessment tool (corresponding sensitivity 87%)¹⁶⁷ to 100% (corresponding sensitivity 98%)¹²¹ using activity measures differentiating ADHD and neurotypical development Specificity ranged from 36% using interview notes and family history data (corresponding sensitivity 89%)⁴³⁴ to 95% (corresponding sensitivity 67%)¹⁸¹ using smart chair data in a clinical sample	C, I	Low
KQ1 Clinician tool	Accuracy	12 studies²⁷^, ¹²¹^, ¹⁸¹^, ²⁹⁸^, ²⁹⁹^, ³⁵⁵^, ³⁸⁸^, ⁴⁰³^, ⁴⁰⁷^, ⁴¹⁶^, ⁴³⁴^, ⁴³⁷	Accuracy ranged from 0.68⁴³⁷ to 0.99¹²¹ using activity measures to differentiate ADHD and neurotypical development Accuracy ranged from 0.61 for individual clinical impressions²⁷ to 0.92 using smart chair data¹⁸¹ in a clinical sample	S, I	Low
KQ1 Clinician tool	AUC	12 studies¹²¹^, ¹⁶⁷^, ¹⁸¹^, ³¹¹^, ³⁵⁵^, ³⁸⁵^, ³⁸⁹^, ⁴⁰⁰^, ⁴⁰⁷^, ⁴¹⁶^, ⁴³⁴^, ⁶²⁷	Activity measures ranged from AUC 0.79⁶²⁷ to 0.9996³⁵⁵ differentiating ADHD and neurotypical development AUC ranged from 0.66 using a combination of medical record indicators⁴³⁴ to 0.98 using smart chair data in a clinical sample	S, I	Low
KQ1 Clinician tools	Rater agreement	2 studies¹⁶⁷^, ⁴⁹⁹	ICC was 0.92 for raters using the DB-DOS¹⁶⁷ differentiating ADHD and neurotypical development Kappa between a clinician interviewer and clinician observing the interview was 0.46⁴⁹⁹ in a clinical sample	C	Low
KQ1 Clinician tools	Internal consistency	2 studies¹⁶⁷^, ³⁸⁵	Cronbach’s alpha was 0.82 for the DB-DOS¹⁶⁷ differentiating ADHD and neurotypical development Cronbach’s alpha was 0.86 for the HDS³⁸⁵ in a clinical sample	C	Low
KQ1 Clinician tools	Test-retest reliability	1 study¹⁶⁷	Test-retest reliability was ICC 0.64 for the DB-DOS¹⁶⁷ differentiating ADHD and neurotypical development	C	Insufficient
KQ1 Clinician tools	Misdiagnosis impact	0 studies	No data	C	Insufficient
KQ1 Clinician tools	Costs	0 studies	No data	C	Insufficient

KQ1 Diagnostic Test

Outcome

Number of Studies and IDs

Findings

Reasons for Downgrading

SoE

KQ1 Clinician tool

Sensitivity

14 studies²⁷^, ¹²¹^, ¹⁶⁷^, ¹⁸¹^, ²⁹⁸^, ²⁹⁹^, ³⁵⁵^, ³⁸⁸^, ⁴⁰⁰^, ⁴⁰³^, ⁴⁰⁷^, ⁴¹⁶^, ⁴¹⁷^, ⁴³⁴

Sensitivity ranged from 25 (corresponding specificity 94%) using actigraph measures taken during CPT task⁴¹⁷ to 100% (corresponding specificity 99%) using extended activity measurement³⁵⁵ differentiating ADHD and neurotypical development

Sensitivity ranged from 63% (corresponding specificity 74%) using a combination of medical record indicators⁴³⁴ to 93% using smart chair data¹⁸¹ in a clinical sample

C, I

Low

KQ1 Clinician tool

Specificity

14 studies²⁷^, ¹²¹^, ¹⁶⁷^, ¹⁸¹^, ²⁹⁸^, ²⁹⁹^, ³⁵⁵^, ³⁸⁸^, ⁴⁰⁰^, ⁴⁰³^, ⁴⁰⁷^, ⁴¹⁶^, ⁴¹⁷^, ⁴³⁴

Specificity ranged from 79% using an observational assessment tool (corresponding sensitivity 87%)¹⁶⁷ to 100% (corresponding sensitivity 98%)¹²¹ using activity measures differentiating ADHD and neurotypical development

Specificity ranged from 36% using interview notes and family history data (corresponding sensitivity 89%)⁴³⁴ to 95% (corresponding sensitivity 67%)¹⁸¹ using smart chair data in a clinical sample

C, I

Low

KQ1 Clinician tool

Accuracy

12 studies²⁷^, ¹²¹^, ¹⁸¹^, ²⁹⁸^, ²⁹⁹^, ³⁵⁵^, ³⁸⁸^, ⁴⁰³^, ⁴⁰⁷^, ⁴¹⁶^, ⁴³⁴^, ⁴³⁷

Accuracy ranged from 0.68⁴³⁷ to 0.99¹²¹ using activity measures to differentiate ADHD and neurotypical development

Accuracy ranged from 0.61 for individual clinical impressions²⁷ to 0.92 using smart chair data¹⁸¹ in a clinical sample

S, I

Low

KQ1 Clinician tool

AUC

12 studies¹²¹^, ¹⁶⁷^, ¹⁸¹^, ³¹¹^, ³⁵⁵^, ³⁸⁵^, ³⁸⁹^, ⁴⁰⁰^, ⁴⁰⁷^, ⁴¹⁶^, ⁴³⁴^, ⁶²⁷

Activity measures ranged from AUC 0.79⁶²⁷ to 0.9996³⁵⁵ differentiating ADHD and neurotypical development

AUC ranged from 0.66 using a combination of medical record indicators⁴³⁴ to 0.98 using smart chair data in a clinical sample

S, I

Low

KQ1 Clinician tools

Rater agreement

2 studies¹⁶⁷^, ⁴⁹⁹

ICC was 0.92 for raters using the DB-DOS¹⁶⁷ differentiating ADHD and neurotypical development

Kappa between a clinician interviewer and clinician observing the interview was 0.46⁴⁹⁹ in a clinical sample

Low

KQ1 Clinician tools

Internal consistency

2 studies¹⁶⁷^, ³⁸⁵

Cronbach’s alpha was 0.82 for the DB-DOS¹⁶⁷ differentiating ADHD and neurotypical development

Cronbach’s alpha was 0.86 for the HDS³⁸⁵ in a clinical sample

Low

KQ1 Clinician tools

Test-retest reliability

1 study¹⁶⁷

Test-retest reliability was ICC 0.64 for the DB-DOS¹⁶⁷ differentiating ADHD and neurotypical development

Insufficient

KQ1 Clinician tools

Misdiagnosis impact

0 studies

No data

Insufficient

KQ1 Clinician tools

Costs

0 studies

No data

Insufficient

From: 4, Results: Diagnosis of ADHD

Cover of ADHD Diagnosis and Treatment in Children and Adolescents

ADHD Diagnosis and Treatment in Children and Adolescents [Internet].

Comparative Effectiveness Review, No. 267.

Peterson BS, Trampush J, Maglione M, et al.

Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Mar.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 6KQ1 summary of findings and strength of evidence for clinician tools