ADHD Assessment Recommendations for Children in Practice Guidelines: A Systematic Review

Round 1

Reviewer 1 Report

The article is very interesting and useful both in research and practice terms. I think that the paper may benefit of a couple of minor adds to its sections.

Introduction

The introduction describes very well the background and the aim of the article. What is missing here is a more precise point on the reasons why this is important. I suggest the authors review the last paragraph by adding the main implication of this study. You could start at row 106 by writing "Studying recommendations is important because... our study will lead to ... etc."

Methods & Results are okay

Discussion

I wonder whether you could provide a sort of integrative view of the guidelines. You correctly defined the features of the guidelines, however, would it be possible to approach the analysis of this guideline in a more integrative way by proposing recommendations for future guidelines? You also mentioned future research. But what can you add in terms of recommendations for ADHD guidelines via this paper? 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

I want to thank the authors of "ADHD assessment recommendations for children in clinical 2 practice guidelines: A systematic review" for a detailed study on developing systematic guidelines on ADHD assessment. The paper is very well-written. I also have a few suggestions to make the study clearer for readers:

1) Can the authors explain the following two inclusion and exclusion criteria a bit more? Some justification about these (and other) criteria in the paper would ne nice. 

- published 133 by a government organisation, NGO commissioned by State/Federal Government (or 134 equivalent overseas) or a National Professional Association

- created by a single author or were 139 written as part of a dissertation

2) Can the authors also add information about whether the guidelines from each document are supported with empirical evidence or not? Sometimes such guidelines come from practical observations without any scientific evidence to support their validity. 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

This is a good review of the diagnostic guidelines and highlights the problem in addressing co-morbidities and confounding factors that obscure the diagnosis.

Although the article is focused on the issue of differential diagnosis and the lack of guidelines in addressing that, it might be worthwhile for the authors to add a table that summarizes the guidelines for making the diagnosis from the article they feel does it best from the 6 articles they summarize. I think this would be helpful for readers and would add a practical aspect to the article.

It might be worth pointing out some of the logistical issues in implementing the diagnostic testing suggested as part of the differential.  For example a full battery of neuropsychological testing can take 1-2 days and may be prohibitively expensive; access to psychiatry is limited in many places, etc.

Re methods:

"Guidelines were then reviewed by a second 162 independent reviewer. Interrater agreement was conducted once all guidelines were viewed by a second rater. Any items with a score difference greater than two points were discussed between raters and scores were reconsidered, resulting in all scores having no 165 more than a two-point difference. Intra-class correlations coefficients to assess the level of agreement between raters were then conducted. "

It seems rather circular to do intra-class correlation coefficients to assess agreement AFTER differences > 2 points were discussed and scores reconsidered.  Of course it will be high after such discussion.  I think just leaving it with the reconsideration and not bothering with coeefficients would be more legitimate.

Author Response

The third reviewer report was emailed to the lead author on Sat 15th October 2022. Responses to this reviewer can be see in the attachment. 

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

appreciate the revisions.  Table 4 is very useful