6.57 COMPLEXITY OF IDENTIFYING ATTENTION-DEFICIT/HYPERACTIVITY DISORDER AND COMORBIDITIES IN A DISADVANTAGED LATINO POPULATION

Objectives: Underserved, minority children are at risk for under-identification of ADHD and comorbidities, and suffer disproportionately from poor outcomes. The goal of this study was to evaluate the clinical validity of parent report screening tools to identify ADHD and comorbidities in a sample of socioeconomically disadvantaged Latino children referred for psychiatric consultation, and to examine the effect of demographics on scores and diagnoses. Methods: Variables extracted by chart review included demographics, diagnoses, and standardized questionnaire results. Analyses assessed agreement between the Pediatric Symptom Checklist Attention Scale (PSC-AS), Child Behavior Checklist ADHD Subscale (CBCL-ADHD), and ADHD diagnosis by a child psychiatrist. Results: Over half of patients were referred for ADHD symptoms, and ninety of the 157 patients evaluated were diagnosed with ADHD, almost all with comorbidities and more than half with multiple comorbidities. Patients with non-English speaking parents were less likely to have completed PSC's and had lower PSC-AS scores. All measures using recommended cut-offs had low sensitivity for ADHD. The PSC-35 had the strongest association with ADHD diagnosis and was least affected by comorbidity, while the CBCL-ADHD scale was more sensitive to highly comorbid ADHD. Using Receiver Operating Characteristics (ROC) curve analysis with the PSC-AS data, a cut-off of 3 provided the most balanced sensitivity and specificity trade-off (sensitivity 0.87, specificity 0.49). Conclusions: Findings suggest that parent-report tools using published cutoff scores have low sensitivity in this population and that non-English speaking parents may under-report symptoms. Therefore, disadvantaged Latino children with ADHD may not be recognized and not treated. Pediatricians should consider using the PSC-35 to screen for ADHD with a lower cut-off point on the PSC AS subscale, followed by careful evaluation to assess for comorbidities. Further research is needed to improve the evaluation of ADHD in disadvantaged, Latino children, and to understand the impact of acculturation and education on diagnosis.