JMIR Publications

ABSTRACT

Background:

Given the global shortage of child psychiatrists and barriers to specialized care, remote assessment is a promising alternative for diagnosing and managing attention-deficit hyperactivity disorder (ADHD). However, only a few studies have validated the accuracy and acceptability of these remote methods.

Objective:

This study aimed to test the agreement between remote and face-to-face assessments.

Methods:

Patients aged 6-17 years with confirmed Diagnostic and Statistical Manual of Mental Disorders diagnoses of ADHD and/or autism spectrum disorder (ASD) were recruited from multiple institutions. In a randomized order, participants underwent two evaluations, face-to-face and remote, with distinct evaluators administering the ADHD Rating Scale-IV(ADHD-RS-IV). Intraclass correlation coefficient (ICC) was used to assess the reliability of face-to-face and remote assessments.

Results:

The participants included 74 Japanese children aged 6-16 years who were primarily diagnosed with ADHD (43 [58.1%, 43/74]) or ASD (31 [41.9%, 31/74]). Twenty-two (29.7%, 22/74) children were diagnosed with both conditions. The ADHD-RS-IV ICCs between face-to-face and remote assessments showed “substantial” agreement in the total ADHD-RS-IV score (ICC=0.769; 95% confidence interval [CI] 0.654-0.849; P<.001), according to the Landis criteria. The ICC in patients with ADHD showed "almost perfect" agreement (ICC=0.816; 95% CI 0.683-0.897; P<.001), whereas in patients with ASD, it showed "substantial" agreement (ICC=0.674; 95% CI 0.420-0.831; P<.001), indicating the high reliability of both methods across both conditions.

Conclusions:

Our large-scale study validated the feasibility and reliability of remote ADHD testing, which has potential benefits such as reduced hospital visits and time-saving effects. Our results highlight the potential of telemedicine in resource-limited areas, clinical trials, and treatment evaluations, necessitating further studies to explore its broader application. Clinical Trial: The study protocol was registered in the UMIN Clinical Trials Registry (UMIN000039860).