TY - JOUR
T1 - Comparing the Effects of Sampling Designs on the Diagnostic Accuracy of Eight Promising Screening Algorithms for Pediatric Bipolar Disorder
AU - Youngstrom, Eric
AU - Meyers, Oren
AU - Youngstrom, Jennifer Kogos
AU - Calabrese, Joseph R.
AU - Findling, Robert L.
PY - 2006/11/1
Y1 - 2006/11/1
N2 - Background: Past studies have used markedly different inclusion and exclusion criteria to form samples used to evaluate diagnostic tests, making it difficult to compare results across studies. The present investigation compared eight screening algorithms in the same sample but under two different design strategies. Methods: The DSM-IV diagnoses were based on a semi-structured diagnostic interview (KSADS) with the parent and youth sequentially. Raters were blind to index test scores. Participants were 216 youths with bipolar spectrum diagnoses and 284 youths with other Axis I diagnoses or no diagnosis. T-tests evaluated whether areas under the curve (AUC) from receiver operating characteristic analyses differed under the two design conditions. Results: All of the instruments discriminated bipolar cases better when inclusion and exclusion criteria duplicated those used in phenomenological research studies selecting narrow phenotypic cases (AUCs ranging from .90 to .81). The measures performed less well when more heterogeneous clinical presentations were included [AUCs ranging from .86 to .69, t(8) = 4.99, p = 001]. Conclusions: Results indicate that checklists perform less well discriminating pediatric bipolar disorder under conditions that more closely resemble clinical practice. Test users must consider whether the sampling strategies and participant characteristics used to evaluate tests match the characteristics of their own patients.
AB - Background: Past studies have used markedly different inclusion and exclusion criteria to form samples used to evaluate diagnostic tests, making it difficult to compare results across studies. The present investigation compared eight screening algorithms in the same sample but under two different design strategies. Methods: The DSM-IV diagnoses were based on a semi-structured diagnostic interview (KSADS) with the parent and youth sequentially. Raters were blind to index test scores. Participants were 216 youths with bipolar spectrum diagnoses and 284 youths with other Axis I diagnoses or no diagnosis. T-tests evaluated whether areas under the curve (AUC) from receiver operating characteristic analyses differed under the two design conditions. Results: All of the instruments discriminated bipolar cases better when inclusion and exclusion criteria duplicated those used in phenomenological research studies selecting narrow phenotypic cases (AUCs ranging from .90 to .81). The measures performed less well when more heterogeneous clinical presentations were included [AUCs ranging from .86 to .69, t(8) = 4.99, p = 001]. Conclusions: Results indicate that checklists perform less well discriminating pediatric bipolar disorder under conditions that more closely resemble clinical practice. Test users must consider whether the sampling strategies and participant characteristics used to evaluate tests match the characteristics of their own patients.
KW - Pediatric bipolar disorder
KW - clinical diagnosis
KW - sampling
KW - sensitivity and specificity
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U2 - 10.1016/j.biopsych.2006.06.023
DO - 10.1016/j.biopsych.2006.06.023
M3 - Article
C2 - 17056395
AN - SCOPUS:33750086966
VL - 60
SP - 1013
EP - 1019
JO - Biological Psychiatry
JF - Biological Psychiatry
SN - 0006-3223
IS - 9
ER -