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Top1. Introduction
Studies have shown that about 3-7% of school-age children have attention deficit hyperactivity disorder (ADHD) (Biederman, et al., 2004; Westby & Watson, 2003). Difficulties with attention, impulsiveness, or hyperactivity (or all three) characterize children diagnosed as having ADHD (DSM-IV-TR, 2002; Barkley, 2006). These deficiencies arise relatively early during childhood (Barkley & Biederman, 1997), are persistent over time in most diagnosed cases (Barkley, 2006), and often result in impairment in multiple domains of major life activities (Barkley, 1997). If ADHD disorders are not attended to and treated early, its consequences may severely impair the adult life of the individual. Early diagnosis of ADHD is therefore crucial to mitigate its effects.
Making a diagnosis is a decision-making activity. Decision-making is an integral and crucial element in health care. All over the globe, clinicians make millions of decisions relating to individual patients everday. Further, healthcare managers and policymakers make thousands of decisions about groups of patients, or populations (Gray, 2001). For an individual patient, the clinician has to diagnose what is wrong and recommend the appropriate treatment, while the patient has to decide whether or not to seek medical care, and whether to accept the recommended treatment. For a group of patients or populations, health policymakers and insurers have to decide, for example, based on the results of trials and past knowledge, what to promote, what to discourage, and what to pay for.
Many of these clinical decisions are, of course, direct and immediately important to patients, and also convey special messages to those who govern and manage healthcare services. Together, these decisions help to determine the quality of health care, and its financial cost. Increasingly, decision makers at all levels are under the pressure to practice medicine cost effectively, as resources are not infinite and changes in policies and clinical practice are the major factors driving the unrelenting increase in healthcare costs (Eddy, 2001).
Research into clinical decision-making, which has been studied for decades, has continued to expand rapidly (Lusted, 1968; Sackett et al., 1997; Wulff & Gotzsche, 2000). Clinical decision-making has interdisciplinary aspects, drawing from both the natural sciences and the humanities (Wulff & Gotzsche, 2000). From the perspective of software engineering, for example, research into clinical decision-making includes use of quantitative theoretical techniques and tools for modeling decisions, use of various scientific methodologies to explore how decisions are actually made, and applied research approaches to uncover how the process of clinical decision-making may be improved. Any clinical decision, whether diagnostic, therapeutic or about policy, is implicitly an argument that the decision is the best choice for the patient, or community, in a given circumstance.