Estimates of the validity and utility of unstructured clinical observations of children in the assessment of ADHD.

The purpose of this prospective study was to examine the validity and diagnostic utility of unstructured clinic observations of attention deficit hyperactivity disorder (ADHD) behaviors in children. Results showed observations to be related to behavioral ratings of parents but not of teachers. The relationship between observations and parent ratings was stronger for hyperactive-impulsive than inattentive behaviors. The level of agreement between observations and classification of ADHD significantly exceeded chance levels only for parent measures of hyperactivity-impulsivity. Only parent measures predicted a diagnosis of ADHD at a rate that was significantly better than chance. Clinic observations were found to have consistently higher positive predictive power than negative predictive power. Clinical implications are discussed.