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

Abstract

Purpose

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.

Methods

Adolescents (N = 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) via tele-videoconferencing platform. The K-CAT-SUD-E assessed both current and lifetime overall SUD and substance-specific diagnoses for nine substance classes.

Results

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.

Conclusions

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.

Keywords:

• Substance use disorder
• item response theory
• computerized adaptive testing
• mental health
• adolescent

Disclosure statement

Robert D. Gibbons is a founder of Adaptive Testing Technologies, which distributes the Computerized Adaptive Test—Mental Health suite of computerized adaptive tests (CAT-MH is a trademark of Adaptive Testing Technologies); the terms of this arrangement have been reviewed and approved by the University of Chicago in accordance with its conflicts of interest policies. The authors report no additional financial or other relationship relevant to the subject of this article. The authors report no additional financial or other relationship relevant to this manuscript. The sponsors had no role in the study design; collection, analysis, or interpretation of data; the writing of the report; nor the decision to submit the manuscript for publication.

Additional information

Funding

The authors gratefully acknowledge the collaborative contributions of the Indiana Family and Social Services Administration Division of Mental Health and Addiction (DMHA) and of the JCOIN Cooperative, funded by the National Institute on Drug Abuse (NIDA) by the National Institutes of Health (NIH; UG1DA050070, U2CDA050098). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of DMHA, NIDA, and NIH, nor any participating sites.