To the Editor: Dr Volkow and colleagues1 studied the biological basis of attention-deficit/hyperactivity disorder (ADHD), using positron emission tomography (PET) to assess dopamine transporters and D2/D3 receptors. This was a study of adult ADHD, which can be overdiagnosed because of symptom overlap with mood and anxiety disorders, and I am concerned that the methods used in this study to evaluate the participants for true ADHD may have been inadequate.
First, the patient sample was more than 50% ADHD inattentive type, which frequently has comorbidity with anxiety and mood disorders.2 Although these comorbidities were cited as exclusion criteria, participants were evaluated by 2 psychiatrists in 3 geographic settings using unpublished semistructured interviews. The generally accepted method for excluding other similar psychiatric syndromes is to use structured, normed, and well-validated instruments such as the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition [DSM-IV]).3 The DSM-IV states that “[ADHD] is not diagnosed if the symptoms are better accounted for by another mental disorder.”4 Moreover, there were no stated agreement data, so it appears that each patient was seen by a single evaluator.
Second, the article did not report the methods used to evaluate normal control participants. Controls must also be evaluated with structured instruments.
Third, although several well-studied rating scales were used, I believe that the Strengths and Weaknesses of ADHD-symptoms and Normal-behavior (SWAN) rating scale is rarely used, and little has been published on its efficacy and reliability.5
Fourth, the article reported that half of the patients with ADHD were women, whereas only one-third of the controls were women. It would be important to know if there were any differences in the data when analyzed by sex.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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