Initial Validation of a Computerized Adaptive Test for Substance Use Disorder Identification in Adolescents

• Published in: Substance use & misuse Vol. 59; no. 6; pp. 867 - 873
• Main Authors: Adams, Zachary W, Hulvershorn, Leslie A, Smoker, Michael P, Marriott, Brigid R, Aalsma, Matthew C, Gibbons, Robert D
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Ltd 2024
• Subjects: Accuracy; Adolescent; Adolescents; Adult; Cannabis; Classification; Clinical assessment; Computerization; Diagnostic tests; Drug use; Ethanol; Feasibility; Humans; Interviews; Marijuana; Medical diagnosis; Nicotine; Opioids; Psychiatric Status Rating Scales; Stimulants; Substance abuse; Substance use disorder; Substance-Related Disorders - diagnosis; Teenagers; Tobacco; Video conferencing; Substance use disorder; adolescent; item response theory; computerized adaptive testing; mental health
• ISSN: 1082-6084; 1532-2491; 1532-2491
• DOI: 10.1080/10826084.2024.2305801

Computerized adaptive tests (CATs) are highly efficient assessment tools that couple low patient and clinician time burden with high diagnostic accuracy. A CAT for substance use disorders (CAT-SUD-E) has been validated in adult populations but has yet to be tested in adolescents. The purpose of this study was to perform initial evaluation of the K-CAT-SUD-E (i.e., Kiddy-CAT-SUD-E) in an adolescent sample compared to a gold-standard diagnostic interview.
Adolescents (
 = 156; aged 11-17) with diverse substance use histories completed the K-CAT-SUD-E electronically and the substance related disorders portion of a clinician-conducted diagnostic interview (K-SADS)
tele-videoconferencing platform. The K-CAT-SUD-E assessed both current and lifetime overall SUD and substance-specific diagnoses for nine substance classes.
Using the K-CAT-SUD-E continuous severity score and diagnoses to predict the presence of any K-SADS SUD diagnosis, the classification accuracy ranged from excellent for current SUD (AUC = 0.89, 95% CI = 0.81, 0.95) to outstanding (AUC = 0.93, 95% CI = 0.82, 0.97) for lifetime SUD. Regarding current substance-specific diagnoses, the classification accuracy was excellent for alcohol (AUC = 0.82), cannabis (AUC = 0.83) and nicotine/tobacco (AUC = 0.90). For lifetime substance-specific diagnoses, the classification accuracy ranged from excellent (e.g., opioids, AUC = 0.84) to outstanding (e.g., stimulants, AUC = 0.96). K-CAT-SUD-E median completion time was 4 min 22 s compared to 45 min for the K-SADS.
This study provides initial support for the K-CAT-SUD-E as a feasible accurate diagnostic tool for assessing SUDs in adolescents. Future studies should further validate the K-CAT-SUD-E in a larger sample of adolescents and examine its acceptability, feasibility, and scalability in youth-serving settings.