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Objective The current diagnostic algorithm for attention-deficit/hyperactivity disorder (ADHD) is not highly predictive of impairment and yields low interrater agreement. The objective of this study was to enhance the diagnostic accuracy of ADHD by identifying the symptoms that are associated with impairment. Method Semistructured interviews and impairment rating scales were administered to parents and teachers of 218 children. Combinations of ADHD symptoms were examined according to a receiver operating characteristic (ROC) based procedure to create diagnostic algorithms that predict impairment. Results In comparison with the DSM-IV, the ROC-based algorithms were 2 to 3 times more efficient in discriminating impaired from nonimpaired children. Parent and teacher agreement was also 3 times higher. Conclusions Limiting the diagnosis to symptoms that predict impairment can increase the validity of the ADHD diagnosis. Results also support the use of ROC analyses in developing better diagnostic algorithms.

Objective To study nonverbal social cue perception in children with attention-deficit/hyperactivity disorder (ADHD; n = 86), conduct problems (CP; n = 24), or both disorders (ADHD+CP; n = 63), as well as normal controls ( n = 27). Method Using a standardized test of receptive nonverbal processing abilities, participants were required to interpret emotional cues from pictures of facial expressions and recordings of voices. Results As predicted, children with CP and ADHD were significantly less accurate at interpreting emotions than normal controls. However, children with CP and ADHD differed in the type of errors made: the ADHD group's errors were generally random in nature, whereas the CP group tended to misinterpret emotions as anger. Contrary to our hypothesis, the ADHD+CP group performed better than the ADHD and CP groups, was as accurate as the control group, and displayed a unique pattern of errors. Conclusions These results support the idea that social deficiencies associated with CP arise from a biased perception of emotion, whereas social problems in ADHD originate from a failure to attend to the appropriate cues of affect. The findings also support the theory that comorbid ADHD+CP is a distinct disorder.