The Weiss Functional Impairment Rating Scale-Parent Form for assessing ADHD: evaluating diagnostic accuracy and determining optimal thresholds using ROC analysis

Abstract

Purpose: The Weiss Functional Impairment Rating Scale-Parent Form (WFIRS-P) is a 50-item scale that assesses functional impairment on six clinically relevant domains typically affected in attention-deficit/hyperactivity disorder (ADHD). As functional impairment is central to ADHD, the WFIRS-P offers potential as a tool for assessing functional impairment in ADHD. These analyses were designed to examine the overall performance of WFIRS-P in differentiating ADHD and non-ADHD cases using receiver operating characteristics (ROC) analysis. This is the first attempt to empirically determine the level of functional impairment that differentiates ADHD children from normal controls.

Methods: This observational study comprised 5-19-year-olds with physician-diagnosed ADHD (n = 476) and non-ADHD controls (n = 202). ROC analysis evaluated the ability of WFIRS-P to discriminate between ADHD and non-ADHD, and identified a WFIRS-P cut-off score that optimises correct classification. Data were analysed for the complete sample, for males versus females and for participants in two age groups (5-12 versus 13-19 years).

Results: Area under the curve (AUC) was 0.91 (95% confidence interval 0.88-0.93) for the overall WFIRS-P score, suggesting highly accurate classification of ADHD distinct from non-ADHD. Sensitivity (0.83) and specificity (0.85) were maximal for a mean overall WFIRS-P score of 0.65, suggesting that this is an appropriate threshold for differentiation. DeLong's test found no significant differences in AUCs for males versus females or 5-12 versus 13-19 years, suggesting that WFIRS-P is an accurate classifier of ADHD across gender and age.

Conclusions: When assessing function, WFIRS-P appears to provide a simple and effective basis for differentiating between individuals with/without ADHD in terms of functional impairment.

Classification: Disease-specific applications of QOL research.

Keywords: Attention-deficit/hyperactivity disorder; Disease classification; Disease severity; Receiver operating characteristics analysis; Weiss functional impairment rating scale.

Conflict of interest statement

Conflict of interest

Trevor Thompson reports no conflicts of interest. Andrew Lloyd has received funding from Shire Development, LLC for his work on this study. Alain Joseph is an employee of Shire and owns stock/stock options. Margaret Weiss has received honoraria and research funding for consultancy from Purdue and honoraria for speakers bureaux from Eli Lilly, Janssen, Rhodes, and Shire.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Figures

Fig. 1

ROC curve describing differentiation of ADHD/non-ADHD across WFIRS-P total scores. AUC area under the curve, ROC receiver operating characteristics, WFIRS-P Weiss Functional Impairment Rating Scale-Parent Form

Fig. 2

Sensitivity and specificity across the range of overall WFIRS-P total scores. WFIRS-P Weiss Functional Impairment Rating Scale-Parent Form

Fig. 3

ROC curves for the overall WFIRS-P total score across gender (a) and age group (b). ROC receiver operating characteristics, WFIRS-P Weiss Functional Impairment Rating Scale-Parent Form