Trastorno por Déficit de Atención e Hiperactividad (TDAH), ¿se mantiene el diagnóstico de sospecha realizado en Atención Primaria en la Unidad de Salud Mental Infanto- Juvenil?

  1. L. Rivas Arribas 1
  2. P. García Cortázar 2
  3. B. Grandío Sanjuán 2
  4. C. Rozados Villaverde 2
  5. M.O. Blanco Barca 3
  6. C. Martínez Reglero 4
  1. 1 Servicio de Pediatría del Hospital Provincial. Xerencia de Xestión Integrada de Pontevedra e O Salnés. Ponte-vedra
  2. 2 Unidad de Salud Mental Infanto-Juvenil. Xerencia de Xestión Integrada de Pontevedra e O Salnés. Pontevedra.
  3. 3 Servicio de Neuropediatría, Hospital Álvaro Cunqueiro. Xerencia de xestión Integrada de Vigo
  4. 4 Unidad de Metodología y Estadística, Instituto de Investigación Sanitaria Galicia Sur. Vigo
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Journal:
Revista de Psiquiatría Infanto-Juvenil

ISSN: 2660-7271,  1130-9512

Year of publication: 2017

Volume: 34

Issue: 1

Pages: 19-26

Type: Article

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More publications in: Revista de Psiquiatría Infanto-Juvenil

Abstract

Introduction: ADHD is one of the most common neurodevelopmental disorders. Primary care (PC) pediatricians often receive patients who show cardinal symptoms of this entity. Objective: To analyze the concordance between the presumptive diagnosis performed in PC and the definitive diagnosis of the Child and Adolescent Mental Health Unit (CAMHU). Materials and methods: Prospective descriptive observational study in which 374 patients under 16 years were recruited from the CAMHU of Pontevedra health area during 2016. The Kappa index was analyzed globally and specific for the different diagnoses. Results: 374 patients were included, 233 were referred with suspected ADHD, confirming the diagnosis in 102 patients. The global kappa concordance index is 0.29. For most diagnoses, agreement was weak. Concordance was good for Autism (0.61) and very good for Eating Disorder (1.00). For ADHD, the sensitivity was 95.33% (95% confidence interval (CI) 90.86-99.79), specificity 50.94% (CI95% 44.75-57.12), positive predictive value 43.78% (CI95% 37.19-50.36) and negative predictive value 96.45% (95% CI 93.05-99.86). Conclusions: The concordance obtained between PC and CAMHU is low in our health area. The diagnostic concordace measured with the kappa index is weak for ADHD, however, it is good for both autism and eating disorders. The diagnostic validity for ADHD is moderate, with a high sensitivity and low specificity.

Bibliographic References

  • American Academy of Pediatrics, Subcommittee on Attention-Deficit/Hyperactivity Disorder. Clinical Practice Guideline. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics 2011; 128: 1007-22.
  • Gutiérrez Miras, MG. Capítulo V: Trastornos mentales y del comportamiento. Clasificación Internacional de Enfermedades. 10ª Edición; 2000. p. 204-207.
  • Ayuso JL, Vieta E, Arango C. Manual diagnóstico y estadístico de los trastornos mentales. Sección II. 5ª Edición; 2014. p. 59-66.
  • Viesser SN, Zablotsky B, Holbroock JR, et al. Diagnostic experiences of children with Attention-Deficit/Hyperactivity Disorder. National Health Statistics Reports 2015; 81: 1-7.
  • Froehlich TE, Lanphear BP, Epstein JN, et al. Prevalence, recognition, and treatment of Attention-Deficit/Hyperactivity Disorder in a National simple of US children. Arch Pediatr Adolesc Med 2007; 161: 837-864.
  • Merikangas KR, He JP, Brody D, et al. Prevalence and treatment of mental disorders among US children in the 2001-2004 NHANES. Pediatrics 2010; 125: 75-81.
  • Catalá-López F, Peiró S, Ridao M, et al. Prevalence of Attention Deficit Hyperactivity Disorder among children and adolescents in Spain: a systematic review and meta-analysis of epidemiological studies. BMC Psychiatry 2012; 12: 168.
  • O`Brien JM, Christner JG, et al. Attention-Deficit Hyperactivity Disorder. National Guideline Clearinghouse 2013.
  • Taylor E, Döfner M, Asherson P, et al. European clinical guidelines for hyperkinetic disorder – first upgrade. Eur Child Adolesc Psychiatry 2004; 13 (S1).
  • National Institute for Health and Clinical Excellence. Attention déficit hyperactivity disorder: Diagnosis and management of ADHD in children, Young people and adults. Issued September 2008, last modified March 2013. Disponible en: http://www.nice.org.uk/CG072
  • Alda Díez JA, Boix Lluch C, Colomé Roura R, et al. Guía de Práctica Clínica sobre el Trastorno por Déficit de Atención con Hiperactividad (TDAH) en Niños y Adolescentes. 2010.
  • Perou R, Bitsko RH, Blumberg SJ, et al. Mental health surveillance among children – United States, 2005-2011.Centers for disease control and prevention MMWR 2013; 62 (No 2).
  • Morán Sánchez I, Navarro Mateu F, Robles Sánchez F, et al. Validez del diagnóstico clínico de trastorno por déficit de atención con hiperactividad en las derivaciones de pediatría a la consulta de psiquiatría infantil. Aten Primaria 2008; 40: 29-33.
  • Concordancia en el diagnóstico entre pediatría y salud mental. An Sst Sanit Navar 2009; 32: 161-168.
  • Pastor PN, Reuben CA. Diagnosed Attention deficit hyperactivity disorder and learning disability: United States, 2004-2006. Vital Health Stat 10. 2008; 237: 1-14.
  • Feldman HM, Reiff MI. Attention deficithyperactivity disorder in children and adolescents. N Engl J Med 2014; 370: 838-846.
  • Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. Lancet 2005; 366: 237-248.
  • Wilms Floet AM, Scheiner C, Grossman L. Attention-deficit/hyperactivity disorder. Pediatrics in Review 2010; 31 (No 2).
  • Escobar MC, de la Barra F, Verdugo C, et al. Interconsultas de pediatría a psiquiatría infantil. Rev Chil Pediatr 1987; 5B(5): 368-373.
  • Martín-Jurado A, de la Gándara Martín JJ, Castro Carbajo S, et al. Análisis de concordancia de las derivaciones de atención primaria a salud mental. Semergen 2012; 38: 354-359.
  • López-Pisón J, Pérez-Delgado R, García-Oguiza A, et al. Neuropediatría y atención primaria. Nuestra experiencia en el siglo XXI. Rev Neurol 2008; 47(S1): S45-S53.
  • Spenser HR, Gillies A, Maysenhoelder H. The CHAT Project: Paediatricians and mental health clinicians: working together for the sake of the children. J Can Acad Child Adolesc Psychiatry 2009; 18: 2.
  • Ross WJ, Chan E, Harris SK, et al. Pediatricianpsychiatrist collaboration to care for children with attention deficit hyperactivity disorder, depression, and anxiety. Clinical Pediatrics 2011; 50: 37-43.
  • Tatlow-Golden M, Prihodova L, Gavin B, et al. What do general practitioners know about ADHD? Attitudes and knowledge among firstcontact gatekeepers: systematic narrative review. BMC Family Practice 2016; 17: 129.
  • Coghill D, Seth S. Effective management of attention-deficit/hyperactivity disorder (ADHD) through structured re-assessment: the Dundee ADHD clinical care pathway. Child Adolesc Psychiatry MEnt Health 2015; 9: 52.
  • Clinton J, Feller AF, Williams RC. The importance of infant mental health. Paediatr Child Health 2016; 21 (No 5).
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