Clinical Summary
Clinical Summary: Validity of an Online Assessment of Attention-Deficit/Hyperactivity Disorder Among a Real-World Sample of Adults Seeking Web-Based Mental Health Care
Adults seeking ADHD care online often face delayed diagnosis and uneven access to behavioral health services, yet clinicians have had little published evidence on whether asynchronous online ADHD assessments are valid. In this help-seeking population, the key clinical question is whether a positive online diagnosis can be trusted and whether a negative result should end the evaluation.
Design
A cross-sectional evaluation of agreement between the diagnoses assigned by clinicians applying DSM-5 criteria during virtual interviews and those assigned by a proprietary, online ADHD assessment was conducted.
N
345
Population
community-dwelling US adults seeking online resources to support ADHD diagnosis, treatment, or management
Duration
1–4 weeks
Key Findings
- The online assessment returned fewer ADHD-positive diagnoses than the clinical interview, with 78.8% of online assessments returning an ADHD-positive result versus 92.8% of clinical interviews.
- Against the clinical interview, the online assessment showed overall accuracy of 78.0% (95% CI, 73.2–82.2%), PPV of 94.9% (95% CI, 92.8–96.3%), sensitivity of 80.6% (95% CI, 75.9–84.8%), specificity of 44.0% (95% CI, 24.4–65.1%), NPV of 15.1% (95% CI, 9.8–22.6%), and κ of 0.13 (SE = 0.06, 95% CI, 0.02–0.24, p < .01).
- More than 80% of discordant cases (62/76) were cases in which the online assessment did not diagnose ADHD when the clinical interview had, confirming that the online assessment was more conservative.
- Compared with adjudicated full-data diagnoses, the online assessment had significantly better PPV and specificity than the clinical interview: PPV was 98.5% (95% CI, 96.4%–99.4%) versus 94.1% (95% CI, 92.2%–95.5%, p < .05), and specificity was 88.2% (95% CI, 72.6%–96.7%) versus 44.1% (95% CI, 27.2%–62.1%, p < .05).
- Compared with adjudicated full-data diagnoses, the clinical interview had significantly higher sensitivity than the online assessment, 96.8% (95% CI, 94.2%–98.5%) versus 86.2% (95% CI, 81.8%–89.8%, p < .05), while the online assessment had a lower false-positive rate in discordant cases, 11.7%; 4/34 versus 55.9%; 19/34.
Clinical Bottom Line
In adults self-referring for web-based ADHD care, a positive online assessment was usually correct and was less likely than interview alone to overcall ADHD. A negative online result did not rule out ADHD and should be followed by further clinical evaluation.
Practice Implications
- Use a positive online ADHD result as a strong rule-in signal in help-seeking adults, given the PPV of 94.9% (95% CI, 92.8–96.3%) against the clinical interview and 98.5% (95% CI, 96.4%–99.4%) against adjudicated full-data diagnoses.
- Do not screen patients out of care after a negative online result, because NPV was 15.1% (95% CI, 9.8–22.6%) and most discordant cases were clinical interview ADHD-positive and online assessment ADHD-negative (62/76).
- When overdiagnosis or unnecessary stimulant exposure is a major concern, the online assessment’s more conservative diagnostic threshold is clinically relevant, with specificity of 88.2% (95% CI, 72.6%–96.7%) and a false-positive rate of 11.7%; 4/34 in discordant cases.
- Apply these performance characteristics to self-referred adults seeking online ADHD care, not to general-population screening, because the sample had a very high ADHD prevalence, with 92.8% ADHD-positive on clinical interview.
