Exploring telediagnostic procedures in child neuropsychiatry: addressing ADHD diagnosis and autism symptoms through supervised machine learning

Abstract

Recently there has been an increase in telemedicine applied to child neuropsychiatry, such as the use of online platforms to remotely collect anamnestic and behavioral information. In the present proof-of-concept study, we aimed to understand to what extent information provided by parents and teachers through online questionnaires overlaps with clinicians’ diagnostic conclusions on Attention-Deficit/Hyperactivity Disorder (ADHD). Moreover, we intended to explore a possible role played by autism spectrum disorders (ASD) symptoms in this process. We examined parent-and teacher-rated questionnaires collected remotely and an on-site evaluation of intelligence quotients from 342 subjects (18% females), aged 3 to 16 years, referred for suspected ADHD. A machine learning model (decision tree, DT) was built to simulate the clinical process of classifying ADHD/non-ADHD. Differences in ASD symptoms in the DT-identified classes were tested to address their role in performing a diagnostic error using the DT model. The DT identified the decision rules adopted by clinicians to classify ADHD diagnosis and proved accurate in 82% of our subjects. The caregiver-reported ADHD core symptom severity proved the most discriminative information for clinicians during the diagnostic decision process. However, ASD symptoms were a confounding factor when ADHD severity had to be established. Telehealth procedures proved effective in obtaining an automated output regarding a diagnostic risk, reducing the time delay between symptom detection and diagnosis. However, this should not be considered as an alternative to on-site procedures but as automated support for clinical practice, enabling clinicians to allocate more resources to the most complex cases.