Thorough clinical child psychiatric diagnostic evaluation and validation of the Autism- Tics, ADHD and other Comorbidities inventory (A-TAC) in a population- based sample of 9-year-olds 

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However, validation against clinical diagnostic assessments in a population-based sample has been lacking. Methods We investigated the psychometric properties of the A-TAC in 263 children who underwent thorough clinical examination within one year of the A-TAC interview. We also mapped the extent of comorbidity of neurodevelopmental disorders. Results Using the A-TAC as screening for neurodevelopmental disorders we could discriminate two groups of children with clearly different occurrences of clinical diagnoses. The predictive screening properties of the A-TAC were good for most of the neurodevelopmental disorders, with exception for developmental coordination disorder. More than 40% of children fulfilling diagnostic criteria for a neurodevelopmental disorder, also fulfilled diagnostic criteria for at least one other neurodevelopmental disorder. Conclusion This study confirms the utility of the A-TAC interview as a screening tool for neuropsychiatric disorders in a non-clinical sample. It also supports the necessity to maintain a broad diagnostic approach in clinical child psychiatric investigations for meaningful understanding of the child’s problems. Children Neurodevelopmental disorders Psychiatric diagnoses Screening validation clinical evaluation Background The awareness of neurodevelopmental disorders (NDD) has increased in the latest decades ( 1 , 2 ). Subsequently, the demand for clinical investigations of NDDs has escalated. Meanwhile, increased mental health issues in children and adolescents overall have been reported ( 3 – 5 ), leading to a considerable strain on the Child and Adolescent Mental Health Services (CAMHS). Taken together CAMHS need means to efficiently direct existing resources. Validated screening tools are suitable for this purpose and are crucial both for clinical and epidemiological purposes to evaluate and further plan individual mental health care, as well as mental health care at an organizational level. The true prevalence of different neurodevelopmental and psychiatric diagnoses in the pediatric population is often debated ( 4 , 6 , 7 ). Estimations of the presence of comorbidity panoramas are especially challenging ( 2 , 8 ) and most prevalence studies or instruments focus on single disorders, not taking into account the vast coexistence ( 9 ). The Autism- Tics, ADHD and other Comorbidities inventory (A-TAC) has been validated cross-sectionally ( 10 – 13 ) and longitudinally ( 14 ). It has also been validated against diagnoses in the national patient register ( 15 ), and has shown excellent psychometric properties for ADHD, autism, and other NDDs in epidemiological settings and in clinical practice. However, a validation in 9–10-year-olds by in-person, clinical diagnostic assessments in a large population-based sample for direct interpretations of epidemiological surveys, remains. Even though A-TAC has shown excellent psychometrics it needs to be validated in close conjunction with the screening procedure. In this study we aimed to further investigate the psychometric properties of the A-TAC in a sample of 9–10-year-olds. We also investigated the patterns and extent of comorbidity of NDDs. Methods Population Study participants were recruited from the longitudinal Child and Adolescent Twin Study in Sweden (CATSS) which has been described in detail elsewhere ( 16 ). Briefly, parents to all twins in Sweden (roughly 1400 twin pairs annually) born July 1992 onwards were contacted for participation in CATSS. Consenting parents were invited to participate in a telephone interview in connection with the twins ninth birthday. Roughly 1400 twin pairs are born annually in Sweden. CATSS has a response rate of 70–80 percent with small differences between responders and non-responders with regards to neuropsychiatric problems when compared to the National Patient Register ( 16 ). The CATSS interview contains the Autism – Tics, AD/HD, and other Comorbidities Inventory (A-TAC, see below) which is used to screen for neuropsychiatric problems. In the present project (CATSS-clinical), all twin pairs within the CATSS residing in the regions of Stockholm, Västra Götaland and Skåne, and where one or both twins screened positive for neuropsychiatric problems, were invited to participate in a clinical neurodevelopmental assessment at the regional site within a year of their screening interview. We also invited 5 percent control pairs, i.e. twin pairs from CATSS from the same regions, where both twins were screen negative. During the time period January 2011 – October 2014 in total 346 twin pairs were eligible for the present study. Of these 346, 90 pairs (27%) could not be reached, 112 pairs (32%) declined participation, 12 pairs (3%) accepted but discontinued participation before the clinical examination. Finally, 132 pairs (38%) attended the clinical examination. In one case only one of the twins attended the clinical examination resulting in a total of 263 clinically examined 9-10-year-old children. Of the children participating in the assessment 46% were screen-positive from the A-TAC interview, the remaining part were controls or screen-negative co-twins The clinical investigators were blinded to the case-ness. Part of the CATSS-clinical population and the instruments have been described in previous publications ( 17 ). Screening (CATSS) As previously mentioned, the A-TAC was used to identify individuals with neuropsychiatric problems. The A-TAC consists of 96 questions that are answered from a life-time perspective. Questions are answered “Yes” (scored as 1), “Yes, to some extent” (scored as 0.5) and “No” (scored as 0) and taps in to virtually all common child and adolescent psychiatric problem constellations. The inventory shows excellent psychometric properties for ADHD, autism, and other NDDs in epidemiological settings and in clinical practice ( 10 – 15 ). In addition, it has excellent inter- and intra-rater reliability ( 14 ). The exact algorithms for inclusion can be found in the endnotes by Anckarsäter et al ( 16 ). Clinical examination (CATSS-clinical) Consenting families were invited to a clinical examination where two experienced clinicians (psychologist, social worker, or resident in child and adolescent psychiatry), blind for the A-TAC data, conducted the clinical examinations. The clinicians had received special training in the use of the instruments before the study. The results and the complete collected materials were validated by a senior child psychiatrist and a decision of a clinical diagnosis was made in consensus with the assessing clinician. In a first step the parent filled out questionnaires regarding ADHD (the Swanson, Nolan, and Pelham ADHD Rating Scale-version IV, SNAP-IV( 18 )) and autism (the Autism Spectrum Screening Questionnaire, ASSQ ( 19 )) respectively, including permission for requisition of relevant medical records. Together with an accompanying parent, one of the twins was interviewed with the Kiddie-SADS-Present and Lifetime Version, covering most psychiatric diagnoses in children, the Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI), and the sensory deviations section from the Diagnostic Interview for Social and Communication Disorders schedule (DISCO), a separate semi structured interview on developmental milestones (on e.g. language and motor functions), and the child underwent a brief clinical neurological investigation, while the other twin was assessed with the WISC-IV (Wechsler intelligence scale for children). The procedure was then reversed. Instruments in CATSS clinical In CATSS-clinical the Kiddie-SADS-Present and Lifetime Version 1.0, (K-SADS) ( 20 ) was used. It is a semi-structured child psychiatric diagnostic interview with child and parent. The version used in this study captures both present and former diagnoses. The K-SADS contains of questions coupled to DSM-IV criteria first in screening fashion, and if screen-positive, then an in-depth-interview regarding the specific disorder(s). K-SADS is widely used in clinical as well as research practices. Furthermore, the section covering sensory deviations from the Diagnostic Interview for Social and Communication Disorders schedule (DISCO) ( 21 , 22 ) was included. In addition, the Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI) ( 23 ), a brief semi-structured parent interview, which consists of 20 questions on symptoms of autism spectrum disorder, and the ADHD & Autismspektrumtillstånd – Observationshjälpmedel (A&O), which is a structured clinician-rated psychiatric observation tool ( 24 ) was included. Finally, the WISC-IV provided standard scores with a mean of 100 and a standard deviation of 15. The Swedish version is based on British norms, which have been tried out and validated against Swedish populations (25). Statistical analyses Validation of the A-TAC interview against clinical diagnosis were made using receiver operating characteristics curves (ROC) to calculate the area under curve (AUC) and thus sensitivity, and specificity, respectively. In addition, and to allow for comparison with other instruments, diagnostic odds ratios, positive predictive values, negative predictive values, as well as accuracy were calculated using the previously defined cut-offs for different A-TAC screening scores ( 11 , 15 ). For ADHD, autism spectrum disorder (ASD), intellectual disability (ID), and developmental coordination disorder (DCD), two predefined cut-offs -one higher and one lower- were available. As the A-TAC interview is asking for lifetime symptoms the validation was made against the presence of ever having fulfilled the clinical diagnosis (either a present or a former diagnosis). The software IBM SPSS Statistics version 28.0.1.1.( 14 ) as well as calculation tools at www.medcalc.org were used for the calculations. Results Clinical diagnoses and comorbidity The frequencies of the present clinical diagnoses are shown in Table 1 . The most prevalent diagnosis in the clinically investigated sample was ADHD (17.5%), followed by tic disorders (10.3%). As expected, when investigating a sample of which a large proportion was screen-positive for neuropsychiatric disorders, the prevalence of autism spectrum disorders was relatively high, > 5%. Of the 120 children classified as controls from the A-TAC interview, 101 were found not to fulfill diagnostic criteria for any NDD; here defined as autism spectrum disorder, ADHD, tic disorder, developmental coordination disorder, intellectual disability, oppositional defiant disorder, conduct disorder, obsessive-compulsive disorder, or early onset restrictive eating disorder. Of the 139 investigated children defined as cases from the A-TAC interview, 73 were found to fulfil criteria for at least one NDD (see Table 2 ). Thus, of the screen-positive participants 52.5%, and only 15.8% of the screen-negative participants, fulfilled criteria for at least one NDD diagnosis after clinical investigation. Table 1 Current clinical diagnoses in the 263 individuals who underwent the clinical investigation. NOS = not otherwise specified, OCD = obsessive-compulsive disorder, DCD = developmental coordination disorder, GAD = generalized anxiety disorder, PTSD = posttraumatic stress disorder, PDD = pervasive developmental disorder diagnosis current current but subsyndromal n % n % Substanse abuse/dependence 0 0 0 0 Eating disorders 1 0.4 0 0 Bipolar/psychotic disorders 0 0 0 0 Tics/Tourette´s disorders 27 10.3 5 1.9 Transient tic disorder 1 0.4 1 0.4 Chronic motor or vocal tic disorder 15 5.7 1 0.4 Tourette´s disorder 8 3.0 3 1.1 Tic disorder NOS 3 1.1 0 0 OCD 2 0.8 0 0 DCD 3 1.1 0 0 Selective mutism 1 0.4 0 0 Specific phobia 13 4.9 3 1.1 Social phobia 1 0.4 1 0.4 Separation anxiety disorder 6 2.3 6 2.3 Panic disorder 3 1.1 1 0.4 Agoraphobia 2 0.8 0 0 GAD 4 1.5 0 0 Anxiety disorder NOS 4 1.5 2 0.8 PTSD 1 0.4 2 0.8 Adjustment disorders 2 0.8 1 0.4 Major depressive disorder 2 0.8 0 0 Depressive disorder NOS 0 0 3 1.1 Dysthymic disorder 0 0 2 0.8 Asperger Syndrome 3 1.1 0 0 PDD-NOS 13 4.9 0 0 Autistic disorder 1 0.4 ADHD 46 17.5 0 0 combined subtype 16 6.1 3 1.1 hyperactive-impulsive subtype 9 3.4 0 0 inattentive subtype 23 8.7 1 0.4 ADHD NOS 9 3.4 0 0 Oppositional Defiant Disorder 14 5.3 1 0.4 Conduct disorder 1 0.4 0 0 Disruptive Behavior Disorder NOS 5 1.9 0 0 Enuresis 13 4.9 8 3.0 Encopresis 8 3.0 2 0.8 Sleep disorders 5 1.9 0 0 Dyslexia 2 0.8 0 0 Communication disorders 5 1.9 0 0 Intellectual Disability 7 2.7 0 0 Table 2 Showing the number of children with number of clinical neurodevelopmental diagnoses (NDDs, including autism spectrum diagnoses, ADHD, tic disorders, developmental coordination disorder, intellectual disability, ODD, CD, OCD, and eating disorders) and comorbidity with anxiety diagnoses (including separation anxiety, panic disorder, specific phobia, agoraphobia, GAD and anxiety NOS) and trauma related diagnoses (including PTSD, acute stress disorder, adjustment disorders). Cases = children screen-positive from the A-TAC interview, Controls = children screen-negative from the A-TAC interview. A-TAC status Nr diagnoses 0 1 2 3 4 5 6 Cases NDDs 66 40 21 10 1 1 0 NDDs + anxiety 56 40 26 9 7 0 1 NDDs + anxiety + trauma 55 40 24 12 7 0 1 controls NDDs 101 15 3 1 0 0 0 NDDs + anxiety 87 24 7 2 0 0 0 NDDs + anxiety + trauma 84 27 7 2 0 0 0 all NDDs 167 55 24 11 1 1 0 NDDs + anxiety 143 64 33 11 7 0 1 NDDs + anxiety + trauma 139 67 31 14 7 0 1 Of the total 92 children with confirmed NDD (73 from the screen positive group and 19 from the negative screen group), > 40% (n = 37) met criteria for more than one NDD. In addition, a substantial presence of comorbidity with anxiety disorders (including separation anxiety, panic disorder, specific phobia, agoraphobia, generalized anxiety disorder, and anxiety NOS) and trauma related diagnoses (including PTSD, acute stress disorder, adjustment disorders), was found, se Table 2 . Psychometric properties of the A-TAC interview (see Table ) Table 3 Validation of ATAC screening interview against clinical diagnoses. (AUC = area under curve, SENS = sensitivity, SPEC = specificity, PPV = positive predictive value, NPV = negative predictive value, DOR = diagnostic odds ratio) diagnosis AUC A-TAC cut-off SENS SPEC PPV NPV Accuracy DOR ADHD .806 6 .661 .772 45.88 88.64 74.71 6.6 12.5 .203 .990 85.71 80.97 81.23 25.53 ASD .866 4.5 .500 .934 38.46 95.74 90.04 14.06 8.5 .250 .988 62.50 94.07 93.10 26.44 tics .828 1.5 .439 .945 60.00 90.00 86.54 13.50 OCD .923 1 .333 .926 5.00 99.17 91.95 6.28 ED .958 1 1.00 .924 4.17 100.00 91.19 1.04 ODD .889 3 .923 .822 21.43 99.51 82.69 55.36 ID .914 1 1.00 .780 11.11 100 78.54 1.12 3 .143 .972 12.50 97.63 95.02 5.88 DCD .616 0.5 .333 .860 2.70 99.11 85.44 3.08 1 .333 .977 14.29 99.21 96.93 21.00 CD .903 2 0 .965 - - - - The predictive screening properties of the A-TAC were good for most of the NDDs here specifically investigated. AUC values ranged from 0.616 (poor; for DCD) to 0.923 (outstanding; for OCD). Discussion This study aimed at investigating the validity of the A-TAC instrument in a large population-based sample of clinically investigated 9-year-olds. The A-TAC proved to be a good to outstanding screening instrument for capturing the different neurodevelopmental diagnoses specifically investigated, except for screening for developmental coordination disorder (DCD). The predictive value of the A-TAC screening in this study with clinical investigations within a year after the A-TAC interview, was overall slightly better than the predictive value when screening was made 3 years before a clinical investigation ( 14 ). For example, the positive predictive value (PPV) for ADHD using the higher cut-off was 63% in the follow-up at 15 years, compared to a PPV of 86% for the same cut-off in the present study. The corresponding PPVs for the higher cut-off for ASD were 60% and 62.5%, respectively. The differences probably reflect the overlap and time changes in the clinical symptom panorama related to neurodevelopmental problems (26). In general, the specificity with the cut-offs we used were good, suggesting that the A-TAC tool is suitable to estimate the presence of clinical diagnostic cases also when used in a population-based sample. However, the sensitivity at the pre-defined cut-offs was lower, which may limit its use for selection for clinical neurodevelopmental investigations. This may further highlight that clinical investigations with too targeted diagnostic questions are not useful for the individual patient. That is, if clinical interviews, in the interest of time efficiency, are too slim, the patient´s symptoms or functional deficits risk to be misinterpreted or not acknowledged at all. Despite this, from our results, and particularly the calculated diagnostic odds ratios reflecting the discriminative properties, it seems that the higher cut-offs would probably be more useful in a clinical context. The lower cut-offs could maybe be more useful if the purpose is to identify individuals that are most likely not cases for specialized psychiatric care. In the present study using the A-TAC screening tool, we could define two groups of children (one screen-positive and one screen-negative) with clearly different prevalence of neuropsychiatric problems fulfilling diagnostic criteria. How these reflect future diagnostic panoramas or future social functioning and what predicts different life trajectories remains to be investigated in future studies. Of note, the prevalence of DCD in our sample was low (1.1%). According to Biotteau et al (27) the prevalence of DCD is 1.8-8% depending on the diagnostic criteria used. In children with e.g. ADHD the prevalence has been estimated as substantially higher ( 9 ). DCD is characterized by slow, clumsy, or inaccurate motor learning and motor performances. It might be that, since abandoning the concept of “deficits in attention, motor control and perception”, DAMP (28), these problems and symptoms are probably not acknowledged in neurodevelopmental investigations. Possibly, when specifically asked for, these symptoms are interpreted as signs of other problems such as e.g. inattention. In the present study brief coordination testing (e.g. diadochokinetic testing) was part of the clinical investigation. This indicates that this kind of test does not easily detect deficits in motor coordination that are not part of a specific neurological disorder. Deficits in rhythm and timing seems to be a common feature in most neurodevelopmental disorders (29) and was recently shown to be predictive of ADHD diagnosis (30). Further, social interaction and motor problems in particular predicted later bully victimization (31). Thus, DCD symptoms may be an area of interest for future studies. Limitations Firstly, many of the eligible children were not reached or declined participation in the present study. Secondly, as the investigated population contained many children selected for neuropsychiatric disorders, our prevalence figures cannot be generalized to the overall population. However, results from the present study highlights the A-TAC as a valid instrument for prevalence estimates in non-clinical samples of children. A third limitation of the present study is the low number of children fulfilling clinical diagnostic criteria for eating disorders and intellectual disability, which limited the possibility to estimate the predictive validity of the A-TAC for these disorders in particular. Conclusion This study confirms the utility of the A-TAC interview as a screening tool for neuropsychiatric disorders in a non-clinical sample. In line with previous extensive literature the rate of comorbid neurodevelopmental as well as other child psychiatric disorders and trauma-related disorder was high. For this reason, our data adds to the fact that clinical child psychiatric investigations should maintain a broad diagnostic approach, and that diagnostically directed clinical child psychiatric investigations lack foundation. Abbreviations A&O ADHD & Autismspektrumtillstånd – Observationshjälpmedel ADHD attention deficit hyperactivity disorder ASD autism spectrum disorder ASDI Asperger Syndrome (and high-functioning autism) Diagnostic Interview AUC area under curve ASSQ Autism Spectrum Screening Questionnaire A-TAC Autism- Tics, ADHD and other Comorbidities inventory CATSS Child and Adolescent Twin Study in Sweden CAMHS Child and Adolescent Mental Health Services DAMP deficits in attention, motor control and perception DCD developmental coordination disorder DISCO Diagnostic Interview for Social and Communication Disorders schedule ID intellectual disability K-SADS Kiddie-SADS-Present and Lifetime Version 1.0 NDD neurodevelopmental disorders PPV positive predictive value ROC receiver operating characteristics curves SNAP-IV Swanson, Nolan, and Pelham ADHD Rating Scale-version IV WISC-IV Wechsler intelligence scale for children Declarations Ethics approval and consent to participate This study was performed in compliance with the Declaration of Helsinki. The study was approved by the regional Ethics Board in Stockholm: Dnr 2010/1099-31/3, 2011/1505-32, 2012/135-32. The legal guardians of all participating children provided written informed consent to participate in the study. Participation was voluntary and participants could at any time cancel further participation. Consent for publication Not applicable Availability of data and materials According to the ethical permit for the study, the data that support the findings of this study are not publicly available. According to (anonymized information) regulations, the data are classified as sensitive personal data. The data are accessible upon specific request from the corresponding author. Competing interests The authors declare no competing interests Funding This work was supported by grants from the Swedish state under the agreement between the Swedish government and the county councils (ALF agreement) (MR: ALFSKANE-197651; ALFSKANE-118971), the Söderström-Königska foundation, the Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), and Faculty-funded clinical research resources (FS 2.1.6-2408-18), Umeå University. Authors’ contributions LH, MR and SL designed the present study. LH, MR and PL designed and implemented the CATSS-clinical study. LH, PG, MJ, EB, JT and SL collected the data. LH performed the analyses. LH wrote the manuscript. SE, PL, PG, CG, MJ, EB, JT MR and SL critically read and revised the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors gratefully acknowledge the patients and their families who participated in the study. References Lai MC. Editorial: Meaningfully Stratifying the Autism Spectra. J Am Acad Child Adolesc Psychiatry. 2020;59(12):1324-6. Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, et al. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789-818. Durbeej N, Sorman K, Noren Selinus E, Lundstrom S, Lichtenstein P, Hellner C, et al. Trends in childhood and adolescent internalizing symptoms: results from Swedish population based twin cohorts. BMC Psychol. 2019;7(1):50. Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry. 2014;53(1):34-46 e2. Zwicker JG, Missiuna C, Harris SR, Boyd LA. Developmental coordination disorder: a pilot diffusion tensor imaging study. Pediatr Neurol. 2012;46(3):162-7. Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry. 2018;5(2):175-86. Lundstrom S, Reichenberg A, Anckarsater H, Lichtenstein P, Gillberg C. Autism phenotype versus registered diagnosis in Swedish children: prevalence trends over 10 years in general population samples. BMJ. 2015;350:h1961. Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol. 2018;28(10):1059-88. Gillberg C, Gillberg IC, Rasmussen P, Kadesjo B, Soderstrom H, Rastam M, et al. Co-existing disorders in ADHD -- implications for diagnosis and intervention. Eur Child Adolesc Psychiatry. 2004;13 Suppl 1:I80-92. Hansson SL, Svanstrom Rojvall A, Rastam M, Gillberg C, Gillberg C, Anckarsater H. Psychiatric telephone interview with parents for screening of childhood autism - tics, attention-deficit hyperactivity disorder and other comorbidities (A-TAC): preliminary reliability and validity. Br J Psychiatry. 2005;187:262-7. Larson T, Anckarsater H, Gillberg C, Stahlberg O, Carlstrom E, Kadesjo B, et al. The autism--tics, AD/HD and other comorbidities inventory (A-TAC): further validation of a telephone interview for epidemiological research. BMC Psychiatry. 2010;10:1. Hallerod SL, Larson T, Stahlberg O, Carlstrom E, Gillberg C, Anckarsater H, et al. The Autism--Tics, AD/HD and other Comorbidities (A-TAC) telephone interview: convergence with the Child Behavior Checklist (CBCL). Nord J Psychiatry. 2010;64(3):218-24. Larson T, Kerekes N, Selinus EN, Lichtenstein P, Gumpert CH, Anckarsater H, et al. Reliability of Autism-Tics, AD/HD, and other Comorbidities (A-TAC) inventory in a test-retest design. Psychol Rep. 2014;114(1):93-103. Larson T, Lundstrom S, Nilsson T, Selinus EN, Rastam M, Lichtenstein P, et al. Predictive properties of the A-TAC inventory when screening for childhood-onset neurodevelopmental problems in a population-based sample. BMC Psychiatry. 2013;13:233. Marland C, Lichtenstein P, Degl'Innocenti A, Larson T, Rastam M, Anckarsater H, et al. The Autism-Tics, ADHD and other Comorbidities inventory (A-TAC): previous and predictive validity. BMC Psychiatry. 2017;17(1):403. Anckarsater H, Lundstrom S, Kollberg L, Kerekes N, Palm C, Carlstrom E, et al. The Child and Adolescent Twin Study in Sweden (CATSS). Twin Res Hum Genet. 2011;14(6):495-508. Asberg Johnels J, Yngvesson P, Billstedt E, Gillberg C, Halldner L, Rastam M, et al. The relationship between intelligence and global adaptive functioning in young people with or without neurodevelopmental disorders. Psychiatry Res. 2021;303:114076. Hall CL, Guo B, Valentine AZ, Groom MJ, Daley D, Sayal K, et al. The Validity of the SNAP-IV in Children Displaying ADHD Symptoms. Assessment. 2020;27(6):1258-71. Posserud MB, Lundervold AJ, Gillberg C. Validation of the autism spectrum screening questionnaire in a total population sample. J Autism Dev Disord. 2009;39(1):126-34. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36(7):980-8. Leekam SR, Libby SJ, Wing L, Gould J, Taylor C. The Diagnostic Interview for Social and Communication Disorders: algorithms for ICD-10 childhood autism and Wing and Gould autistic spectrum disorder. J Child Psychol Psychiatry. 2002;43(3):327-42. Wing L, Leekam SR, Libby SJ, Gould J, Larcombe M. The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use. J Child Psychol Psychiatry. 2002;43(3):307-25. Gillberg C, Gillberg C, Rastam M, Wentz E. The Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI): a preliminary study of a new structured clinical interview. Autism. 2001;5(1):57-66. Bejerot S, Nylander L. ADHD & Autismspektrumtillstånd – Observationshjälpmedel (A&O) 2009 [Available from: https://psykiatristod.se/utredningar-och-skalor/skattningsskalor-adhd Wechsler D. WISC-IV Wechsler Intelligence scale for children. Fjärde utgåvan på svenska. Pearson Assessment 2007. Anckarsater H. Beyond categorical diagnostics in psychiatry: Scientific and medicolegal implications. Int J Law Psychiatry. 2010;33(2):59-65. Biotteau M, Albaret JM, Chaix Y. Developmental coordination disorder. Handb Clin Neurol. 2020;174:3-20. Gillberg C. Deficits in attention, motor control, and perception: a brief review. Arch Dis Child. 2003;88(10):904-10. Lense MD, Ladanyi E, Rabinowitch TC, Trainor L, Gordon R. Rhythm and timing as vulnerabilities in neurodevelopmental disorders. Philos Trans R Soc Lond B Biol Sci. 2021;376(1835):20200327. Gustafsson P, Kjell K, Cundari M, Larsson M, Edbladh J, Madison G, et al. The ability to maintain rhythm is predictive of ADHD diagnosis and profile. BMC Psychiatry. 2023;23(1):920. Torn P, Pettersson E, Lichtenstein P, Anckarsater H, Lundstrom S, Hellner Gumpert C, et al. Childhood neurodevelopmental problems and adolescent bully victimization: population-based, prospective twin study in Sweden. Eur Child Adolesc Psychiatry. 2015;24(9):1049-59. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Oct, 2025 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 25 Aug, 2025 Reviews received at journal 16 Aug, 2025 Reviewers agreed at journal 07 Aug, 2025 Reviewers agreed at journal 23 Jul, 2025 Reviews received at journal 22 Jul, 2025 Reviewers agreed at journal 17 Jul, 2025 Reviewers invited by journal 28 Apr, 2025 Editor assigned by journal 25 Apr, 2025 Editor invited by journal 24 Apr, 2025 Submission checks completed at journal 23 Apr, 2025 First submitted to journal 23 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6375046","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":448879244,"identity":"e441e601-35fb-44d6-8b99-58b666ed94a1","order_by":0,"name":"Linda Halldner","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBACPmYGBgkGhgMMfOwMBkC+DWEtbDAtQAZISxoRWhhQtRwmQgs778EbPxjuyLMxM2978HHP+cS1MxKYP3zA6zC+ZMsehmeGbcxs5YYznt1O3HYjgU1yBl4tPGYSPAyHGduADGmeAxAtzDwEtEj+YThsD9by58A5kBbmz38IaJEG2pII1sJw4ABIC4M0Xu8z8xhbyxgcTgb6pUyy50Cy8bYzD9ske/Bo4ec/Y3jzTcVh23725m0SPw7YyW47nnz4ww981oCBAQqPsYGghlEwCkbBKBgF+AEA++NGDBp6X84AAAAASUVORK5CYII=","orcid":"","institution":"Umeå University","correspondingAuthor":true,"prefix":"","firstName":"Linda","middleName":"","lastName":"Halldner","suffix":""},{"id":448879245,"identity":"4f86d666-8099-401a-b887-164803c2fac5","order_by":1,"name":"Sophia Eberhard","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Sophia","middleName":"","lastName":"Eberhard","suffix":""},{"id":448879246,"identity":"d701f4ae-21b2-4102-8f33-c8f83511a5ce","order_by":2,"name":"Paul Lichtenstein","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Lichtenstein","suffix":""},{"id":448879247,"identity":"1ad657c2-019c-496f-b318-549c5005e794","order_by":3,"name":"Peik Gustafsson","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Peik","middleName":"","lastName":"Gustafsson","suffix":""},{"id":448879248,"identity":"32d19161-dd45-4546-a301-3952a359d367","order_by":4,"name":"Christopher Gillberg","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"","lastName":"Gillberg","suffix":""},{"id":448879249,"identity":"f4c08610-a010-4909-b9f8-f42f95a2b139","order_by":5,"name":"Mats Johnson","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Mats","middleName":"","lastName":"Johnson","suffix":""},{"id":448879250,"identity":"de18018b-ab3b-400c-9d9a-f5e1c3ceb25d","order_by":6,"name":"Eva Billstedt","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Eva","middleName":"","lastName":"Billstedt","suffix":""},{"id":448879251,"identity":"52c9a4f9-fb08-4b30-9238-87438d984629","order_by":7,"name":"Jakob Täljemark","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Jakob","middleName":"","lastName":"Täljemark","suffix":""},{"id":448879252,"identity":"01ee1c9f-b9ab-4054-982b-7f10b03d1c8c","order_by":8,"name":"Maria Råstam","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Råstam","suffix":""},{"id":448879253,"identity":"f6e21437-b841-4977-811e-2939b3fda430","order_by":9,"name":"Sebastian Lundström","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Lundström","suffix":""}],"badges":[],"createdAt":"2025-04-04 09:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6375046/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6375046/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-07475-y","type":"published","date":"2025-10-02T15:57:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92883930,"identity":"0e5d83f6-1f58-4fc4-b3a3-aeaaf22267c5","added_by":"auto","created_at":"2025-10-06 16:11:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":858753,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6375046/v1/ebc7afe7-249a-4f4d-b092-3a8708889fd3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Thorough clinical child psychiatric diagnostic evaluation and validation of the Autism- Tics, ADHD and other Comorbidities inventory (A-TAC) in a population- based sample of 9-year-olds ","fulltext":[{"header":"Background","content":"\u003cp\u003eThe awareness of neurodevelopmental disorders (NDD) has increased in the latest decades (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Subsequently, the demand for clinical investigations of NDDs has escalated. Meanwhile, increased mental health issues in children and adolescents overall have been reported (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), leading to a considerable strain on the Child and Adolescent Mental Health Services (CAMHS). Taken together CAMHS need means to efficiently direct existing resources. Validated screening tools are suitable for this purpose and are crucial both for clinical and epidemiological purposes to evaluate and further plan individual mental health care, as well as mental health care at an organizational level.\u003c/p\u003e \u003cp\u003eThe true prevalence of different neurodevelopmental and psychiatric diagnoses in the pediatric population is often debated (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Estimations of the presence of comorbidity panoramas are especially challenging (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and most prevalence studies or instruments focus on single disorders, not taking into account the vast coexistence (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Autism- Tics, ADHD and other Comorbidities inventory (A-TAC) has been validated cross-sectionally (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and longitudinally (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). It has also been validated against diagnoses in the national patient register (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and has shown excellent psychometric properties for ADHD, autism, and other NDDs in epidemiological settings and in clinical practice. However, a validation in 9\u0026ndash;10-year-olds by in-person, clinical diagnostic assessments in a large population-based sample for direct interpretations of epidemiological surveys, remains. Even though A-TAC has shown excellent psychometrics it needs to be validated in close conjunction with the screening procedure.\u003c/p\u003e \u003cp\u003eIn this study we aimed to further investigate the psychometric properties of the A-TAC in a sample of 9\u0026ndash;10-year-olds. We also investigated the patterns and extent of comorbidity of NDDs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eStudy participants were recruited from the longitudinal Child and Adolescent Twin Study in Sweden (CATSS) which has been described in detail elsewhere (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Briefly, parents to all twins in Sweden (roughly 1400 twin pairs annually) born July 1992 onwards were contacted for participation in CATSS. Consenting parents were invited to participate in a telephone interview in connection with the twins ninth birthday. Roughly 1400 twin pairs are born annually in Sweden. CATSS has a response rate of 70\u0026ndash;80 percent with small differences between responders and non-responders with regards to neuropsychiatric problems when compared to the National Patient Register (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The CATSS interview contains the Autism \u0026ndash; Tics, AD/HD, and other Comorbidities Inventory (A-TAC, see below) which is used to screen for neuropsychiatric problems.\u003c/p\u003e \u003cp\u003eIn the present project (CATSS-clinical), all twin pairs within the CATSS residing in the regions of Stockholm, V\u0026auml;stra G\u0026ouml;taland and Sk\u0026aring;ne, and where one or both twins screened positive for neuropsychiatric problems, were invited to participate in a clinical neurodevelopmental assessment at the regional site within a year of their screening interview. We also invited 5 percent control pairs, i.e. twin pairs from CATSS from the same regions, where both twins were screen negative. During the time period January 2011 \u0026ndash; October 2014 in total 346 twin pairs were eligible for the present study. Of these 346, 90 pairs (27%) could not be reached, 112 pairs (32%) declined participation, 12 pairs (3%) accepted but discontinued participation before the clinical examination. Finally, 132 pairs (38%) attended the clinical examination. In one case only one of the twins attended the clinical examination resulting in a total of 263 clinically examined 9-10-year-old children. Of the children participating in the assessment 46% were screen-positive from the A-TAC interview, the remaining part were controls or screen-negative co-twins The clinical investigators were blinded to the case-ness. Part of the CATSS-clinical population and the instruments have been described in previous publications (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eScreening (CATSS)\u003c/h3\u003e\n\u003cp\u003eAs previously mentioned, the A-TAC was used to identify individuals with neuropsychiatric problems. The A-TAC consists of 96 questions that are answered from a life-time perspective. Questions are answered \u0026ldquo;Yes\u0026rdquo; (scored as 1), \u0026ldquo;Yes, to some extent\u0026rdquo; (scored as 0.5) and \u0026ldquo;No\u0026rdquo; (scored as 0) and taps in to virtually all common child and adolescent psychiatric problem constellations.\u003c/p\u003e \u003cp\u003eThe inventory shows excellent psychometric properties for ADHD, autism, and other NDDs in epidemiological settings and in clinical practice (\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In addition, it has excellent inter- and intra-rater reliability (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The exact algorithms for inclusion can be found in the endnotes by Anckars\u0026auml;ter et al (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eClinical examination (CATSS-clinical)\u003c/h3\u003e\n\u003cp\u003eConsenting families were invited to a clinical examination where two experienced clinicians (psychologist, social worker, or resident in child and adolescent psychiatry), blind for the A-TAC data, conducted the clinical examinations. The clinicians had received special training in the use of the instruments before the study. The results and the complete collected materials were validated by a senior child psychiatrist and a decision of a clinical diagnosis was made in consensus with the assessing clinician. In a first step the parent filled out questionnaires regarding ADHD (the Swanson, Nolan, and Pelham ADHD Rating Scale-version IV, SNAP-IV(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)) and autism (the Autism Spectrum Screening Questionnaire, ASSQ (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)) respectively, including permission for requisition of relevant medical records. Together with an accompanying parent, one of the twins was interviewed with the Kiddie-SADS-Present and Lifetime Version, covering most psychiatric diagnoses in children, the Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI), and the sensory deviations section from the Diagnostic Interview for Social and Communication Disorders schedule (DISCO), a separate semi structured interview on developmental milestones (on e.g. language and motor functions), and the child underwent a brief clinical neurological investigation, while the other twin was assessed with the WISC-IV (Wechsler intelligence scale for children). The procedure was then reversed.\u003c/p\u003e\n\u003ch3\u003eInstruments in CATSS clinical\u003c/h3\u003e\n\u003cp\u003eIn CATSS-clinical the Kiddie-SADS-Present and Lifetime Version 1.0, (K-SADS) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) was used. It is a semi-structured child psychiatric diagnostic interview with child and parent. The version used in this study captures both present and former diagnoses. The K-SADS contains of questions coupled to DSM-IV criteria first in screening fashion, and if screen-positive, then an in-depth-interview regarding the specific disorder(s). K-SADS is widely used in clinical as well as research practices. Furthermore, the section covering sensory deviations from the Diagnostic Interview for Social and Communication Disorders schedule (DISCO) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) was included. In addition, the Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), a brief semi-structured parent interview, which consists of 20 questions on symptoms of autism spectrum disorder, and the ADHD \u0026amp; Autismspektrumtillst\u0026aring;nd \u0026ndash; Observationshj\u0026auml;lpmedel (A\u0026amp;O), which is a structured clinician-rated psychiatric observation tool (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) was included. Finally, the WISC-IV provided standard scores with a mean of 100 and a standard deviation of 15. The Swedish version is based on British norms, which have been tried out and validated against Swedish populations (25).\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eValidation of the A-TAC interview against clinical diagnosis were made using receiver operating characteristics curves (ROC) to calculate the area under curve (AUC) and thus sensitivity, and specificity, respectively. In addition, and to allow for comparison with other instruments, diagnostic odds ratios, positive predictive values, negative predictive values, as well as accuracy were calculated using the previously defined cut-offs for different A-TAC screening scores (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). For ADHD, autism spectrum disorder (ASD), intellectual disability (ID), and developmental coordination disorder (DCD), two predefined cut-offs -one higher and one lower- were available. As the A-TAC interview is asking for lifetime symptoms the validation was made against the presence of ever having fulfilled the clinical diagnosis (either a present or a former diagnosis).\u003c/p\u003e \u003cp\u003eThe software IBM SPSS Statistics version 28.0.1.1.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) as well as calculation tools at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.medcalc.org\" target=\"_blank\"\u003ewww.medcalc.org\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.medcalc.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e were used for the calculations.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eClinical diagnoses and comorbidity\u003c/h2\u003e \u003cp\u003eThe frequencies of the present clinical diagnoses are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The most prevalent diagnosis in the clinically investigated sample was ADHD (17.5%), followed by tic disorders (10.3%). As expected, when investigating a sample of which a large proportion was screen-positive for neuropsychiatric disorders, the prevalence of autism spectrum disorders was relatively high, \u0026gt;\u0026thinsp;5%. Of the 120 children classified as controls from the A-TAC interview, 101 were found not to fulfill diagnostic criteria for any NDD; here defined as autism spectrum disorder, ADHD, tic disorder, developmental coordination disorder, intellectual disability, oppositional defiant disorder, conduct disorder, obsessive-compulsive disorder, or early onset restrictive eating disorder. Of the 139 investigated children defined as cases from the A-TAC interview, 73 were found to fulfil criteria for at least one NDD (see Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Thus, of the screen-positive participants 52.5%, and only 15.8% of the screen-negative participants, fulfilled criteria for at least one NDD diagnosis after clinical investigation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCurrent clinical diagnoses in the 263 individuals who underwent the clinical investigation. NOS\u0026thinsp;=\u0026thinsp;not otherwise specified, OCD\u0026thinsp;=\u0026thinsp;obsessive-compulsive disorder, DCD\u0026thinsp;=\u0026thinsp;developmental coordination disorder, GAD\u0026thinsp;=\u0026thinsp;generalized anxiety disorder, PTSD\u0026thinsp;=\u0026thinsp;posttraumatic stress disorder, PDD\u0026thinsp;=\u0026thinsp;pervasive developmental disorder\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ecurrent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ecurrent but subsyndromal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubstanse abuse/dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEating disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar/psychotic disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTics/Tourette\u0026acute;s disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransient tic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic motor or vocal tic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTourette\u0026acute;s disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTic disorder NOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelective mutism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecific phobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial phobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparation anxiety disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePanic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgoraphobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety disorder NOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjustment disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor depressive disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepressive disorder NOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysthymic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsperger Syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDD-NOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAutistic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eADHD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecombined subtype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehyperactive-impulsive subtype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003einattentive subtype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADHD NOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOppositional Defiant Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConduct disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisruptive Behavior Disorder NOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnuresis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEncopresis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslexia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntellectual Disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShowing the number of children with number of clinical neurodevelopmental diagnoses (NDDs, including autism spectrum diagnoses, ADHD, tic disorders, developmental coordination disorder, intellectual disability, ODD, CD, OCD, and eating disorders) and comorbidity with anxiety diagnoses (including separation anxiety, panic disorder, specific phobia, agoraphobia, GAD and anxiety NOS) and trauma related diagnoses (including PTSD, acute stress disorder, adjustment disorders). Cases\u0026thinsp;=\u0026thinsp;children screen-positive from the A-TAC interview, Controls\u0026thinsp;=\u0026thinsp;children screen-negative from the A-TAC interview.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA-TAC status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNr diagnoses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u0026thinsp;+\u0026thinsp;anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u0026thinsp;+\u0026thinsp;anxiety\u0026thinsp;+\u0026thinsp;trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u0026thinsp;+\u0026thinsp;anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u0026thinsp;+\u0026thinsp;anxiety\u0026thinsp;+\u0026thinsp;trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u0026thinsp;+\u0026thinsp;anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDDs\u0026thinsp;+\u0026thinsp;anxiety\u0026thinsp;+\u0026thinsp;trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the total 92 children with confirmed NDD (73 from the screen positive group and 19 from the negative screen group), \u0026gt;\u0026thinsp;40% (n\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;37) met criteria for more than one NDD. In addition, a substantial presence of comorbidity with anxiety disorders (including separation anxiety, panic disorder, specific phobia, agoraphobia, generalized anxiety disorder, and anxiety NOS) and trauma related diagnoses (including PTSD, acute stress disorder, adjustment disorders), was found, se Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePsychometric properties of the A-TAC interview (see Table )\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eValidation of ATAC screening interview against clinical diagnoses. (AUC\u0026thinsp;=\u0026thinsp;area under curve, SENS\u0026thinsp;=\u0026thinsp;sensitivity, SPEC\u0026thinsp;=\u0026thinsp;specificity, PPV\u0026thinsp;=\u0026thinsp;positive predictive value, NPV\u0026thinsp;=\u0026thinsp;negative predictive value, DOR\u0026thinsp;=\u0026thinsp;diagnostic odds ratio)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA-TAC cut-off\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSENS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSPEC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePPV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNPV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAccuracy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDOR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e88.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e74.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e81.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.934\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e90.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e94.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e93.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e86.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e99.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e91.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e91.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e99.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e82.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e55.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eID\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e78.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e97.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e99.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e85.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e99.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e96.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe predictive screening properties of the A-TAC were good for most of the NDDs here specifically investigated. AUC values ranged from 0.616 (poor; for DCD) to 0.923 (outstanding; for OCD).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed at investigating the validity of the A-TAC instrument in a large population-based sample of clinically investigated 9-year-olds. The A-TAC proved to be a good to outstanding screening instrument for capturing the different neurodevelopmental diagnoses specifically investigated, except for screening for developmental coordination disorder (DCD).\u003c/p\u003e \u003cp\u003eThe predictive value of the A-TAC screening in this study with clinical investigations within a year after the A-TAC interview, was overall slightly better than the predictive value when screening was made 3 years before a clinical investigation (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For example, the positive predictive value (PPV) for ADHD using the higher cut-off was 63% in the follow-up at 15 years, compared to a PPV of 86% for the same cut-off in the present study. The corresponding PPVs for the higher cut-off for ASD were 60% and 62.5%, respectively. The differences probably reflect the overlap and time changes in the clinical symptom panorama related to neurodevelopmental problems (26). In general, the specificity with the cut-offs we used were good, suggesting that the A-TAC tool is suitable to estimate the presence of clinical diagnostic cases also when used in a population-based sample. However, the sensitivity at the pre-defined cut-offs was lower, which may limit its use for selection for clinical neurodevelopmental investigations. This may further highlight that clinical investigations with too targeted diagnostic questions are not useful for the individual patient. That is, if clinical interviews, in the interest of time efficiency, are too slim, the patient\u0026acute;s symptoms or functional deficits risk to be misinterpreted or not acknowledged at all. Despite this, from our results, and particularly the calculated diagnostic odds ratios reflecting the discriminative properties, it seems that the higher cut-offs would probably be more useful in a clinical context. The lower cut-offs could maybe be more useful if the purpose is to identify individuals that are most likely \u003cem\u003enot\u003c/em\u003e cases for specialized psychiatric care. In the present study using the A-TAC screening tool, we could define two groups of children (one screen-positive and one screen-negative) with clearly different prevalence of neuropsychiatric problems fulfilling diagnostic criteria. How these reflect future diagnostic panoramas or future social functioning and what predicts different life trajectories remains to be investigated in future studies.\u003c/p\u003e \u003cp\u003eOf note, the prevalence of DCD in our sample was low (1.1%). According to Biotteau et al (27) the prevalence of DCD is 1.8-8% depending on the diagnostic criteria used. In children with e.g. ADHD the prevalence has been estimated as substantially higher (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). DCD is characterized by slow, clumsy, or inaccurate motor learning and motor performances. It might be that, since abandoning the concept of \u0026ldquo;deficits in attention, motor control and perception\u0026rdquo;, DAMP (28), these problems and symptoms are probably not acknowledged in neurodevelopmental investigations. Possibly, when specifically asked for, these symptoms are interpreted as signs of other problems such as e.g. inattention. In the present study brief coordination testing (e.g. diadochokinetic testing) was part of the clinical investigation. This indicates that this kind of test does not easily detect deficits in motor coordination that are not part of a specific neurological disorder. Deficits in rhythm and timing seems to be a common feature in most neurodevelopmental disorders (29) and was recently shown to be predictive of ADHD diagnosis (30). Further, social interaction and motor problems in particular predicted later bully victimization (31). Thus, DCD symptoms may be an area of interest for future studies.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eFirstly, many of the eligible children were not reached or declined participation in the present study. Secondly, as the investigated population contained many children selected for neuropsychiatric disorders, our prevalence figures cannot be generalized to the overall population. However, results from the present study highlights the A-TAC as a valid instrument for prevalence estimates in non-clinical samples of children. A third limitation of the present study is the low number of children fulfilling clinical diagnostic criteria for eating disorders and intellectual disability, which limited the possibility to estimate the predictive validity of the A-TAC for these disorders in particular.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms the utility of the A-TAC interview as a screening tool for neuropsychiatric disorders in a non-clinical sample. In line with previous extensive literature the rate of comorbid neurodevelopmental as well as other child psychiatric disorders and trauma-related disorder was high. For this reason, our data adds to the fact that clinical child psychiatric investigations should maintain a broad diagnostic approach, and that diagnostically directed clinical child psychiatric investigations lack foundation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eA\u0026amp;O\u0026nbsp; \u0026nbsp; \u0026nbsp;ADHD \u0026amp; Autismspektrumtillstånd – Observationshjälpmedel\u003c/p\u003e\n\u003cp\u003eADHD\u0026nbsp; \u0026nbsp;attention deficit hyperactivity disorder\u003c/p\u003e\n\u003cp\u003eASD\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;autism spectrum disorder\u003c/p\u003e\n\u003cp\u003eASDI Asperger Syndrome (and high-functioning autism) Diagnostic Interview\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAUC\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;area under curve\u003c/p\u003e\n\u003cp\u003eASSQ\u0026nbsp; \u0026nbsp;\u0026nbsp;Autism Spectrum Screening Questionnaire\u003c/p\u003e\n\u003cp\u003eA-TAC\u0026nbsp;\u0026nbsp;Autism- Tics, ADHD and other Comorbidities inventory\u003c/p\u003e\n\u003cp\u003eCATSS\u0026nbsp;\u0026nbsp;Child and Adolescent Twin Study in Sweden\u003c/p\u003e\n\u003cp\u003eCAMHS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Child and Adolescent Mental Health Services\u003c/p\u003e\n\u003cp\u003eDAMP\u0026nbsp; deficits in attention, motor control and perception\u003c/p\u003e\n\u003cp\u003eDCD\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;developmental coordination disorder\u003c/p\u003e\n\u003cp\u003eDISCO Diagnostic Interview for Social and Communication Disorders schedule\u003c/p\u003e\n\u003cp\u003eID\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;intellectual disability\u003c/p\u003e\n\u003cp\u003eK-SADS\u0026nbsp; Kiddie-SADS-Present and Lifetime Version 1.0\u003c/p\u003e\n\u003cp\u003eNDD\u0026nbsp; \u0026nbsp; \u0026nbsp;neurodevelopmental disorders\u003c/p\u003e\n\u003cp\u003ePPV \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;positive predictive value\u003c/p\u003e\n\u003cp\u003eROC\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;receiver operating characteristics curves\u003c/p\u003e\n\u003cp\u003eSNAP-IV\u0026nbsp; Swanson, Nolan, and Pelham ADHD Rating Scale-version IV\u003c/p\u003e\n\u003cp\u003eWISC-IV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Wechsler intelligence scale for children\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in compliance with the Declaration of Helsinki. The study was approved by the regional Ethics Board in Stockholm: Dnr 2010/1099-31/3, 2011/1505-32, 2012/135-32. The legal guardians of all participating children provided written informed consent to participate in the study. Participation was voluntary and participants could at any time cancel further participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the ethical permit for the study, the data that support the findings of this study are not publicly available. According to (anonymized information) regulations, the data are classified as sensitive personal data. The data are accessible upon specific request from the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from the Swedish state under the agreement between the Swedish government and the county councils (ALF agreement) (MR: ALFSKANE-197651; ALFSKANE-118971), the\u0026nbsp;Söderström-Königska foundation,\u0026nbsp;the Karolinska\u003c/p\u003e\n\u003cp\u003eInstitutet Center of Neurodevelopmental Disorders (KIND),\u0026nbsp;and Faculty-funded clinical research resources (FS 2.1.6-2408-18), Umeå University.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors’ contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLH, MR and SL designed the present study. LH, MR and PL designed and implemented the CATSS-clinical study. LH, PG, MJ, EB, JT and SL collected the data. LH performed the analyses. LH wrote the manuscript. SE, PL, PG, CG, MJ, EB, JT MR and SL critically read and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the patients and their families who participated in the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLai MC. Editorial: Meaningfully Stratifying the Autism Spectra. J Am Acad Child Adolesc Psychiatry. 2020;59(12):1324-6.\u003c/li\u003e\n\u003cli\u003eFaraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, et al. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789-818.\u003c/li\u003e\n\u003cli\u003eDurbeej N, Sorman K, Noren Selinus E, Lundstrom S, Lichtenstein P, Hellner C, et al. Trends in childhood and adolescent internalizing symptoms: results from Swedish population based twin cohorts. BMC Psychol. 2019;7(1):50.\u003c/li\u003e\n\u003cli\u003eVisser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry. 2014;53(1):34-46 e2.\u003c/li\u003e\n\u003cli\u003eZwicker JG, Missiuna C, Harris SR, Boyd LA. Developmental coordination disorder: a pilot diffusion tensor imaging study. Pediatr Neurol. 2012;46(3):162-7.\u003c/li\u003e\n\u003cli\u003eSayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry. 2018;5(2):175-86.\u003c/li\u003e\n\u003cli\u003eLundstrom S, Reichenberg A, Anckarsater H, Lichtenstein P, Gillberg C. Autism phenotype versus registered diagnosis in Swedish children: prevalence trends over 10 years in general population samples. BMJ. 2015;350:h1961.\u003c/li\u003e\n\u003cli\u003eFranke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol. 2018;28(10):1059-88.\u003c/li\u003e\n\u003cli\u003eGillberg C, Gillberg IC, Rasmussen P, Kadesjo B, Soderstrom H, Rastam M, et al. Co-existing disorders in ADHD -- implications for diagnosis and intervention. Eur Child Adolesc Psychiatry. 2004;13 Suppl 1:I80-92.\u003c/li\u003e\n\u003cli\u003eHansson SL, Svanstrom Rojvall A, Rastam M, Gillberg C, Gillberg C, Anckarsater H. Psychiatric telephone interview with parents for screening of childhood autism - tics, attention-deficit hyperactivity disorder and other comorbidities (A-TAC): preliminary reliability and validity. Br J Psychiatry. 2005;187:262-7.\u003c/li\u003e\n\u003cli\u003eLarson T, Anckarsater H, Gillberg C, Stahlberg O, Carlstrom E, Kadesjo B, et al. The autism--tics, AD/HD and other comorbidities inventory (A-TAC): further validation of a telephone interview for epidemiological research. BMC Psychiatry. 2010;10:1.\u003c/li\u003e\n\u003cli\u003eHallerod SL, Larson T, Stahlberg O, Carlstrom E, Gillberg C, Anckarsater H, et al. The Autism--Tics, AD/HD and other Comorbidities (A-TAC) telephone interview: convergence with the Child Behavior Checklist (CBCL). Nord J Psychiatry. 2010;64(3):218-24.\u003c/li\u003e\n\u003cli\u003eLarson T, Kerekes N, Selinus EN, Lichtenstein P, Gumpert CH, Anckarsater H, et al. Reliability of Autism-Tics, AD/HD, and other Comorbidities (A-TAC) inventory in a test-retest design. Psychol Rep. 2014;114(1):93-103.\u003c/li\u003e\n\u003cli\u003eLarson T, Lundstrom S, Nilsson T, Selinus EN, Rastam M, Lichtenstein P, et al. Predictive properties of the A-TAC inventory when screening for childhood-onset neurodevelopmental problems in a population-based sample. BMC Psychiatry. 2013;13:233.\u003c/li\u003e\n\u003cli\u003eMarland C, Lichtenstein P, Degl'Innocenti A, Larson T, Rastam M, Anckarsater H, et al. The Autism-Tics, ADHD and other Comorbidities inventory (A-TAC): previous and predictive validity. BMC Psychiatry. 2017;17(1):403.\u003c/li\u003e\n\u003cli\u003eAnckarsater H, Lundstrom S, Kollberg L, Kerekes N, Palm C, Carlstrom E, et al. The Child and Adolescent Twin Study in Sweden (CATSS). Twin Res Hum Genet. 2011;14(6):495-508.\u003c/li\u003e\n\u003cli\u003eAsberg Johnels J, Yngvesson P, Billstedt E, Gillberg C, Halldner L, Rastam M, et al. The relationship between intelligence and global adaptive functioning in young people with or without neurodevelopmental disorders. Psychiatry Res. 2021;303:114076.\u003c/li\u003e\n\u003cli\u003eHall CL, Guo B, Valentine AZ, Groom MJ, Daley D, Sayal K, et al. The Validity of the SNAP-IV in Children Displaying ADHD Symptoms. Assessment. 2020;27(6):1258-71.\u003c/li\u003e\n\u003cli\u003ePosserud MB, Lundervold AJ, Gillberg C. Validation of the autism spectrum screening questionnaire in a total population sample. J Autism Dev Disord. 2009;39(1):126-34.\u003c/li\u003e\n\u003cli\u003eKaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36(7):980-8.\u003c/li\u003e\n\u003cli\u003eLeekam SR, Libby SJ, Wing L, Gould J, Taylor C. The Diagnostic Interview for Social and Communication Disorders: algorithms for ICD-10 childhood autism and Wing and Gould autistic spectrum disorder. J Child Psychol Psychiatry. 2002;43(3):327-42.\u003c/li\u003e\n\u003cli\u003eWing L, Leekam SR, Libby SJ, Gould J, Larcombe M. The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use. J Child Psychol Psychiatry. 2002;43(3):307-25.\u003c/li\u003e\n\u003cli\u003eGillberg C, Gillberg C, Rastam M, Wentz E. The Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI): a preliminary study of a new structured clinical interview. Autism. 2001;5(1):57-66.\u003c/li\u003e\n\u003cli\u003eBejerot S, Nylander L. ADHD \u0026amp; Autismspektrumtillst\u0026aring;nd \u0026ndash; Observationshj\u0026auml;lpmedel (A\u0026amp;O) 2009 [Available from: https://psykiatristod.se/utredningar-och-skalor/skattningsskalor-adhd\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"25\"\u003e\n\u003cli\u003eWechsler D. WISC-IV Wechsler Intelligence scale for children. Fj\u0026auml;rde utg\u0026aring;van p\u0026aring; svenska. Pearson Assessment 2007.\u003c/li\u003e\n\u003cli\u003eAnckarsater H. Beyond categorical diagnostics in psychiatry: Scientific and medicolegal implications. Int J Law Psychiatry. 2010;33(2):59-65.\u003c/li\u003e\n\u003cli\u003eBiotteau M, Albaret JM, Chaix Y. Developmental coordination disorder. Handb Clin Neurol. 2020;174:3-20.\u003c/li\u003e\n\u003cli\u003eGillberg C. Deficits in attention, motor control, and perception: a brief review. Arch Dis Child. 2003;88(10):904-10.\u003c/li\u003e\n\u003cli\u003eLense MD, Ladanyi E, Rabinowitch TC, Trainor L, Gordon R. Rhythm and timing as vulnerabilities in neurodevelopmental disorders. Philos Trans R Soc Lond B Biol Sci. 2021;376(1835):20200327.\u003c/li\u003e\n\u003cli\u003eGustafsson P, Kjell K, Cundari M, Larsson M, Edbladh J, Madison G, et al. The ability to maintain rhythm is predictive of ADHD diagnosis and profile. BMC Psychiatry. 2023;23(1):920.\u003c/li\u003e\n\u003cli\u003eTorn P, Pettersson E, Lichtenstein P, Anckarsater H, Lundstrom S, Hellner Gumpert C, et al. Childhood neurodevelopmental problems and adolescent bully victimization: population-based, prospective twin study in Sweden. Eur Child Adolesc Psychiatry. 2015;24(9):1049-59.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Children, Neurodevelopmental disorders, Psychiatric diagnoses, Screening validation, clinical evaluation","lastPublishedDoi":"10.21203/rs.3.rs-6375046/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6375046/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Autism- Tics, ADHD and other Comorbidities inventory (A-TAC) has been validated cross-sectionally, longitudinally, and validated against diagnoses in epidemiological data. However, validation against clinical diagnostic assessments in a population-based sample has been lacking.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe investigated the psychometric properties of the A-TAC in 263 children who underwent thorough clinical examination within one year of the A-TAC interview. We also mapped the extent of comorbidity of neurodevelopmental disorders.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eUsing the A-TAC as screening for neurodevelopmental disorders we could discriminate two groups of children with clearly different occurrences of clinical diagnoses. The predictive screening properties of the A-TAC were good for most of the neurodevelopmental disorders, with exception for developmental coordination disorder. More than 40% of children fulfilling diagnostic criteria for a neurodevelopmental disorder, also fulfilled diagnostic criteria for at least one other neurodevelopmental disorder.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study confirms the utility of the A-TAC interview as a screening tool for neuropsychiatric disorders in a non-clinical sample. It also supports the necessity to maintain a broad diagnostic approach in clinical child psychiatric investigations for meaningful understanding of the child\u0026rsquo;s problems.\u003c/p\u003e","manuscriptTitle":"Thorough clinical child psychiatric diagnostic evaluation and validation of the Autism- Tics, ADHD and other Comorbidities inventory (A-TAC) in a population- based sample of 9-year-olds ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-03 13:36:53","doi":"10.21203/rs.3.rs-6375046/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-25T13:29:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-16T20:15:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89667919879341153845190419074809504175","date":"2025-08-08T00:18:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44219101002276609792857728556160912542","date":"2025-07-23T11:11:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-22T15:33:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136788523045494826095141069480473267122","date":"2025-07-17T14:43:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-28T06:48:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-25T12:09:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-24T12:01:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-23T20:13:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-04-23T11:04:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"60c04ea4-fde2-4633-bc86-e7f239f79cba","owner":[],"postedDate":"May 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:05:39+00:00","versionOfRecord":{"articleIdentity":"rs-6375046","link":"https://doi.org/10.1186/s12888-025-07475-y","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2025-10-02 15:57:24","publishedOnDateReadable":"October 2nd, 2025"},"versionCreatedAt":"2025-05-03 13:36:53","video":"","vorDoi":"10.1186/s12888-025-07475-y","vorDoiUrl":"https://doi.org/10.1186/s12888-025-07475-y","workflowStages":[]},"version":"v1","identity":"rs-6375046","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6375046","identity":"rs-6375046","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}