Key Takeaways

From the Authors As published in the article
  1. Access to ADHD assessment and treatment in the US is variable and often inadequate. Online diagnostic evaluations may help address access barriers, but their accuracy and validity is unknown.
  2. These results lend credibility to online mental health assessments as reliable, accurate, and valid tools for diagnosing ADHD in adults and suggest that they hold significant potential to help address mental health care access barriers globally.
Extended Takeaways
  1. In this self-referred population, pretest probability was extremely high: 92.8% were ADHD-positive on clinical interview and 78.8% on the online assessment. Clinicians should interpret these performance characteristics as applying to help-seeking adults, not to general screening in lower-prevalence settings.
  2. A positive online result was rarely contradicted by the interview standard, with PPV of 94.9% (95% CI, 92.8–96.3%). This supports using a positive online assessment to expedite next-step treatment planning or confirmatory clinical review rather than restarting the diagnostic workup from scratch.
  3. Negative online results were much less reassuring, with NPV of 15.1% (95% CI, 9.8–22.6%), and over 80% of off-diagonal cases (62/76) were interview-positive but online-negative. Adults with persistent impairment despite a negative online result should still receive clinician follow-up rather than being screened out of care.
  4. Against adjudicated full-data diagnoses, the online assessment traded higher rule-in performance for lower rule-out performance: PPV was 98.5% (95% CI, 96.4%–99.4%) and specificity was 88.2% (95% CI, 72.6%–96.7%), while the clinical interview had higher sensitivity at 96.8% (95% CI, 94.2%–98.5%). In practice, the online tool appears better for avoiding false positives, whereas interview remains stronger when the priority is minimizing missed ADHD.
  5. The false-positive rate for the online assessment was 11.7%; 4/34 versus 55.9%; 19/34 for the clinical interview in discordant cases. For clinicians concerned about overdiagnosis or unnecessary stimulant exposure in telehealth pathways, this more conservative threshold is a clinically relevant strength.
  6. Subtype distribution did not explain disagreement: combined and inattentive presentations were most common, and no presentation was consistently misclassified or over-represented among off-diagonal cases. This suggests discordance was more about diagnostic threshold than systematic failure to detect a particular ADHD presentation.
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Physicians Postgraduate Press, Inc. (PPP) makes no warranties about the accuracy or completeness of any information published in The Journal of Clinical Psychiatry or other PPP materials, and disclaims liability for any use or non-use of that information. Clinicians should not rely solely on these materials and should exercise their own professional judgment when making patient care decisions on an individualized basis.

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