Assessing ADHD in children: A randomized controlled trial to estimate reliability, validity, and cost-effectiveness of a brief versus a comprehensive assessment protocol

ADHD is one of the most prevalent psychiatric conditions, consuming a large proportion of resources in psychiatric care, often accompanied by long waiting lists to receive proper assessment. The number of ADHD cases has increased, possible due to heightened awareness of the condition. There are large regional prevalence differences, potentially due to variations in assessments procedures.

Many clinicians and parents view the diagnostic process as too extensive, taking time from treatment and interventions. In addition, assessments may be perceived as too focused on diagnostic criteria to be fully helpful. Systematic research on how assessment procedures can be optimized is essentially lacking.

It is largely unknown whether brief protocols including medical history, diagnostic interview, and rating scales differ from comprehensive protocols that also encompass neuropsychological testing regarding validity, reliability, gender ratio, and patient satisfaction.

Further, feasible biomarkers (i.e. heart rate variability and pupil dilation) of the autonomic nervous system have been proposed as indicators of diagnostic status.

The aim of this study is to gain knowledge about diagnostic processes to enable valid, reliable, and cost-effective ADHD assessments.

Using a randomized controlled trial design (N = 240 children, 5-17-years, referred to child and adolescent psychiatric units in Uppsala and Västerbotten), we will examine differences between a brief and a comprehensive ADHD assessment protocol regarding assessment outcome, reliability, validity, patient satisfaction, and future outcome taking gender into account.

We will explore diagnostic sensitivity and specificity of the included assessment instruments and estimate cost-effectiveness of the brief and comprehensive protocols to enable policy makers to make informed decisions.

The project will further provide important knowledge for patients and clinicians, and inform our understanding of mechanisms underpinning ADHD.