Do parental concerns predict a diagnosis of attention-deficit hyperactivity disorder?

Parents' concerns for their children's behavior were investigated to predict a diagnosis of attention-deficit hyperactivity disorder (ADHD) in this retrospective comparative study of 245 children, aged 4 through 15 years (mean = 8.1 years), consecutively referred for comprehensive pediatric evaluation of school problems between 1981 and 1992. Concerns identified by parents were categorized (inattention, impulsivity, overactivity) and compared to children's final diagnoses of ADHD to measure their sensitivity, specificity, and predictive value. For 92% of subjects, significant school-related problems were diagnosed and 38% received a diagnosis of ADHD. Parental concern for one or more major symptoms of ADHD identified almost all of the children with a diagnosis of ADHD (sensitivity = .87), but also identified many children without such a diagnosis (specificity = .41). Concerns with impulsivity and overactivity were specific (.82, .87) but not sensitive (.38, .29). Concerns with attention had modest sensitivity (.57) and specificity (.57). Positive predictive value was modest for all categories of concerns (.45 to .57). Findings support the importance of eliciting parents' concerns for their children's school performance and of performing comprehensive assessment to identify the underlying causes of problems with attention.