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BMC Psychiatry
Published in: BMC Psychiatry 1/2011

Open Access 01-12-2011 | Research article

The impact of study design and diagnostic approach in a large multi-centre ADHD study. Part 1: ADHD symptom patterns

Authors: Ueli C Müller, Philip Asherson, Tobias Banaschewski, Jan K Buitelaar, Richard P Ebstein, Jaques Eisenberg, Michael Gill, Iris Manor, Ana Miranda, Robert D Oades, Herbert Roeyers, Aribert Rothenberger, Joseph A Sergeant, Edmund JS Sonuga-Barke, Margaret Thompson, Stephen V Faraone, Hans-Christoph Steinhausen

Published in: BMC Psychiatry | Issue 1/2011

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Abstract

Background

The International Multi-centre ADHD Genetics (IMAGE) project with 11 participating centres from 7 European countries and Israel has collected a large behavioural and genetic database for present and future research. Behavioural data were collected from 1068 probands with the combined type of attention deficit/hyperactivity disorder (ADHD-CT) and 1446 'unselected' siblings. The aim was to analyse the IMAGE sample with respect to demographic features (gender, age, family status, and recruiting centres) and psychopathological characteristics (diagnostic subtype, symptom frequencies, age at symptom detection, and comorbidities). A particular focus was on the effects of the study design and the diagnostic procedure on the homogeneity of the sample in terms of symptom-based behavioural data, and potential consequences for further analyses based on these data.

Methods

Diagnosis was based on the Parental Account of Childhood Symptoms (PACS) interview and the DSM-IV items of the Conners' teacher questionnaire. Demographics of the full sample and the homogeneity of a subsample (all probands) were analysed by using robust statistical procedures which were adjusted for unequal sample sizes and skewed distributions. These procedures included multi-way analyses based on trimmed means and winsorised variances as well as bootstrapping.

Results

Age and proband/sibling ratios differed between participating centres. There was no significant difference in the distribution of gender between centres. There was a significant interaction between age and centre for number of inattentive, but not number of hyperactive symptoms. Higher ADHD symptom frequencies were reported by parents than teachers. The diagnostic symptoms differed from each other in their frequencies. The face-to-face interview was more sensitive than the questionnaire. The differentiation between ADHD-CT probands and unaffected siblings was mainly due to differences in hyperactive/impulsive symptoms.

Conclusions

Despite a symptom-based standardized inclusion procedure according to DSM-IV criteria with defined symptom thresholds, centres may differ markedly in probands' ADHD symptom frequencies. Both the diagnostic procedure and the multi-centre design influence the behavioural characteristics of a sample and, thus, may bias statistical analyses, particularly in genetic or neurobehavioral studies.
Appendix
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Metadata
Title
The impact of study design and diagnostic approach in a large multi-centre ADHD study. Part 1: ADHD symptom patterns
Authors
Ueli C Müller
Philip Asherson
Tobias Banaschewski
Jan K Buitelaar
Richard P Ebstein
Jaques Eisenberg
Michael Gill
Iris Manor
Ana Miranda
Robert D Oades
Herbert Roeyers
Aribert Rothenberger
Joseph A Sergeant
Edmund JS Sonuga-Barke
Margaret Thompson
Stephen V Faraone
Hans-Christoph Steinhausen
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2011
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-11-54

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