This manual provides symptoms which the doctor will be looking for in their diagnosis. The clinician will review the diagnostic criteria and determine if any apply to the individual. Patients should also bring up what issues led them to make the decision to have an evaluation. Often people with ADHD will have holes in their memory or they will downplay symptoms.
A significant other such as a partner, sibling, parent, or longtime friend can help fill in these gaps. Often patients will receive rating scales for themselves and for a loved one or significant other to complete. Rating scales are separate from an in-person interview. Patients undergoing evaluation for ADHD should also receive a medical examination. Thyroid problems and seizure conditions can cause symptoms that resemble those of ADHD. Doctors will also look to see if any co-existing conditions exist.
Often if the co-existing condition is not treated then the treatment for ADHD will not be as effective. Many people find that having a diagnosis of ADHD helps them make sense of their life and past decisions. You will want to discuss treatment options with your doctor. Treatment can include lifestyle changes, medication, and therapy, and often includes more than one component. Although there is no single medical, physical, or genetic test for ADHD, a diagnostic evaluation can be provided by a qualified mental health care professional or physician who gathers information from multiple sources.
These sources include ADHD symptom checklists, standardized behavior rating scales, a detailed history of past and current functioning, and information obtained from family members or significant others who know the person well. Some practitioners will also conduct tests of cognitive ability and academic achievement in order to rule out a possible learning disability.
A diagnosis of ADHD must include consideration of the possible presence of co-occurring conditions. These established guidelines are widely used in research and clinical practice. During an evaluation, the clinician will try to determine the extent to which these symptoms currently apply to the adult and if they have been present in childhood. In making the diagnosis, adults should have at least five of the symptoms present. These symptoms can change over time, so adults may fit different presentations from when they were children. The symptoms for each are adapted and summarized below.
A diagnosis of ADHD is determined by the clinician based on the number and severity of symptoms, the duration of symptoms and the degree to which these symptoms cause impairment in various areas of life, such as home, school or work; with friends or relatives; or in other activities. It is possible to meet diagnostic criteria for ADHD without any symptoms of hyperactivity and impulsivity. The clinician must further determine if these symptoms are caused by other conditions, or are influenced by co-existing conditions. Several of the symptoms must have been present prior to age This generally requires corroboration by a parent or some other informant.
Examples of impairment include losing a job because of ADHD symptoms, experiencing excessive conflict and distress in a marriage, getting into financial trouble because of impulsive spending, failure to pay bills in a timely manner or being put on academic probation in college due to failing grades. There are many Internet sites about ADHD that offer various types of questionnaires and lists of symptoms. Most of these questionnaires are not standardized or scientifically validated and should not be used to self-diagnose or to diagnose others with ADHD. A valid diagnosis can only be provided by a qualified, licensed professional.
For adults, an ADHD diagnostic evaluation should be conducted by a licensed mental health professional or a physician. These professionals include clinical psychologists, physicians psychiatrist, neurologist, family doctor or other type of physician or clinical social workers. Whichever type of professional is chosen, it is important to ask about their training and experience in working with adults with ADHD.
Qualified professionals are usually willing to provide information about their training and experience with adults with ADHD. Reluctance to provide such information in response to reasonable requests should be regarded with suspicion and may be an indicator that the individual should seek out a different professional. Ask your personal physician for a referral to a health care professional in your community who is qualified to perform ADHD evaluations for adults. It may also be helpful to call a local university-based hospital, a medical school or a graduate school in psychology for recommendations.
If there is an ADHD support group in your area, it may be very helpful to go there and talk with the people attending the group. Moreover, children whose onset of symptoms was sometime during the childhood years prior to 13 should be considered as having a valid disorder rather than adhering strictly to the DSM-IV age-of-onset of seven years old as the demarcation of a valid case of disorder. Where sex differences exist, they indicate that girls with ADHD show less severe symptoms of both inattention and hyperactive-impulsive behavior, especially in school, fewer symptoms of Oppositional Defiant Disorder ODD and Conduct Disorder CD , greater intellectual deficits, and more symptoms of anxiety and depression than do ADHD boys.
While the original 18 symptoms from the DSM-IV remain in use, as do the two dimensions for their presentation, they are followed by clarifications in parentheses to guide clinicians in applying those symptoms to teens and adults. The threshold of six of nine symptoms on either of the two lists of symptoms remains for application to children and teens. But for adults, this threshold is reduced to five symptoms. The requirements in DSM-IV that symptoms occur often or more frequently, that they be developmentally inappropriate, and that they have persisted for at least the prior six months are all carried forward into DSM The age of onset has been adjusted upward from seven to 12 years of age, consistent with evidence that the lower onset was invalid, too restrictive, and contributed to clinical unreliability of diagnosis.
Also remaining are the requirements for symptoms to be impairing across several settings and that there be impairment in major life activities. A new requirement is that symptoms given by self-report must be corroborated through someone else who knows the subject well or through other sources. The subtypes have been removed respecting abundant evidence that ADHD is a single disorder that varies in severity in the human population, which is not changed by the fact that some people have more inattention than hyperactive-impulsive symptoms and vice-versa.
Even so, clinicians will be provided the opportunity to specify which symptom dimension may be more predominant, as in ADHD Predominantly Inattentive Presentation. When feasible, clinicians may wish to supplement these components of the evaluation with objective assessments of the ADHD symptoms, such as psychological tests of attention or direct behavioral observations.
These tests are not essential to reaching a diagnosis, however, or to treatment planning, but when abnormal findings are detected, they may yield further information about the presence and severity of cognitive impairments that could be associated with some cases of ADHD.
The problem is that the presence of normal scores are largely meaningless given the high proportion of ADHD cases that place in the normal range on such tests. In other words, abnormal scores may be meaningful in indicating the presence of a disorder not necessarily ADHD while normal scores should go uninterpreted given the high false negative rate of many ADHD tests. I also briefly discuss the essential features of the medical examination of ADHD children and issues that examination needs to address.
This discussion is followed by an overview of some of the most useful behavior-rating scales to incorporate into the clinical evaluation. A brief review of the role of psychological tests and direct observations in the evaluation is then presented. Readers wishing to acquire some of the clinical tools referenced here can find them listed in the Resource section. The information contained herein was initially drawn chiefly from my earlier chapters on assessment in my Handbook for Diagnosis and Treatment Barkley, Clinicians should bear in mind several goals when evaluating children for ADHD.
A major goal of such an assessment is the determination of the presence or absence of ADHD as well as the differential diagnosis of ADHD from other childhood psychiatric disorders. For further discussion on gender, socioeconomic status, and cross-cultural issues related to diagnosis and prevalence of ADHD, please see the first course in this series titled ADHD: Nature, Course, Outcomes, and Comorbidity.
A second purpose of the evaluation is to begin delineating the types of interventions needed to address the psychiatric disorders and psychological, academic, and social impairments identified in the course of assessment. As noted later, these may include individual counseling, parent training in behavior management, family therapy, classroom behavior modification, psychiatric medications, and formal special educational services, to name just a few.
Another important purpose of the evaluation is to determine conditions that often coexist with ADHD and the manner in which these conditions may affect prognosis or treatment decision-making. For instance, the presence of high levels of physically assaultive behavior by a child with ADHD may indicate that a parent training program is contraindicated, at least for the time being, because such training in limit-setting and behavior-modification could temporarily increase child violence toward parents when limits on noncompliance with parental commands are established.
- Attention-Deficit / Hyperactivity Disorder | Johns Hopkins Psychiatry Guide?
- New in the ADHDT-2.
- Describing and Modeling Variation in Grammar.
Or, consider the presence of high levels of anxiety specifically — and internalizing symptoms more generally — in children with ADHD. Research shows that such symptoms may be a predictor of poorer responses to stimulant medication, although the point is arguable due to mixed results across studies on this issue. Similarly, the presence of high levels of irritable mood, severely hostile and defiant behavior, and periodic episodes of serious physical aggression and destructive behavior may be early markers for Disruptive Mood Dysregulation Disorder.
If coupled with mania, grandiosity, and sleep or sexual disturbances, they may be early markers for later Bipolar Disorder Manic-Depression in children. Oppositional behavior is almost universal in both disorders, though of a more extreme nature than on its own. Such a disorder is likely to require the use of several psychiatric medications in conjunction with a parent training program and occasionally even inpatient hospitalization. As the foregoing discussion illustrates, the evaluation of a child for the presence of diagnosable ADHD is but one of many purposes of the clinical evaluation.
A brief discussion now follows regarding the different methods of assessment that may be used in the evaluation of ADHD children. The initial phase of a diagnostic interview might not be conducted by the clinician but by a support staff member. The initial phone intake provides invaluable information when conducted by a well-trained individual; otherwise, it is a lost opportunity.
When a parent calls to request an evaluation, it is useful to collect the following information:. The content of the diagnostic interview is influenced by all these factors and important information can be collected and reviewed ahead of time when the reason for the referral is clear. Once the child is referred for services, the clinician must glean some important details from the telephone interview.
This information also allows the clinician to set in motion some initial procedures. In particular, it is important at this point to do the following:. In fact, the parents of children referred to our clinic are not given an appointment date until these packets of information are completed and returned to the clinic. This system ensures that the packets are completed reasonably promptly and that the information is available for review by the clinician prior to meeting with the family, making the evaluation process far more efficient in its collection of important information.
In these days of increasing cost-consciousness concerning mental health evaluations, particularly in managed care environments, efficiency of the evaluation is paramount, and time spent directly with the family is often limited and at a premium. In addition to a form cover-letter from the professional asking the parents to complete and return the entire packet of information, the packet also contains the General Instruction Sheet, a Child and Family Information Form, and a Developmental and Medical History Form.
Also in this packet should be a copy of a rating scale that specifically assesses ADHD symptoms. Such a form can also be found in the clinical manual by DuPaul and colleagues ; see Resources. Clinicians who wish to assess adaptive behavior via the use of a questionnaire might consider including the Normative Adaptive Behavior Checklist in this packet or have parents complete this form on the day of the evaluation. Impairment in major domains of life activities is a required criterion for all Axis I psychiatric disorders in the DSM More recently, a normed rating scale of impairment has been created that can be included with this packet for obtaining information on 15 different domains of life activities in children Barkley Functional Impairment Scale — Children and Adolescents.
Such information is of clinical interest not only for indications of pervasiveness and severity of behavior problems, but also for focusing discussions around these situations during the evaluation and subsequent parent-training program. These rating scales are discussed later. It is useful to collect and review previous records before the interview. They might include any one or combination of the following: report cards, standardized testing results, medical records including neurology, audiology, optometry, speech, and occupational therapy , individual educational plans, psychoeducational testing, psychological testing, and psychotherapy summaries.
A similar packet of information is sent to the teachers of this child, with prior parental written permission, of course. This packet does not contain the Medical and Developmental History Form or any adaptive behavior survey that may have been included for parents. Once the parent and teacher packets are returned, the family should be contacted by telephone and given their appointment date.
It is our custom also to send out a letter confirming this appointment date with directions for driving to the clinic. On the day of the appointment, the following is to be done: 1 parental and child interview, 2 completion of self-report rating scales by the parents, and 3 any psychological testing that may be indicated by the nature of the referral intelligence and achievement testing, etc.
The parent interview, although often criticized for its unreliability and subjectivity, is an indispensable part of the evaluation of children and adolescents presenting with concerns about ADHD. No adult is likely to have more wealth of knowledge about, history of interactions with, or sheer time spent with a child than the parents. Moreover, the reliability and accuracy of the parental interview have much to do with the manner in which it is conducted and the specificity of the questions offered by the examiner.
An interview that uses highly specific questions about symptoms of psychopathology that have been empirically demonstrated to have a high degree of association with particular disorders greatly enhances diagnostic reliability. The interview, particularly a semi-structured interview, allows the clinician in a sense to become another instrument in the assessment process. While scorable data are obtained, the small details and nuances of parent and child reporting resonates with clinician-acquired knowledge from previous interviews, research, readings, workshops, etc.
In other words, the interview provides the phenomenological data that rating scales cannot capture. The suggestions that follow for interviewing parents of ADHD children are not intended as rigid guidelines, only as areas that clinicians should consider. Each interview clearly differs according to individual child and family circumstances. Generally, those areas of importance to an evaluation include demographic information, child-related information, school-related information, and details about the parents, other family members, and community resources that may be available to the family.
If not obtained in advance, routine demographic data concerning the child and family e. The interview then proceeds to the major referral concerns of the parents, and of the professional referring the child when appropriate. General descriptions of concerns by parents must be followed with specific questions by the examiner to elucidate the details of the problems and any apparent precipitants. Such an interview probes for the specific nature, frequency, age of onset, and chronicity of the problematic behaviors.
Although some children with ADHD are reported to have been difficult in their temperament since birth or early infancy, the majority appear to be identifiable as deviant from normal by their caregivers between 3 and 4 years of age. However, it may be several years later before such children are brought to the attention of professionals.
Although the diagnosis of ADHD among preschoolers may be more difficult due to higher rates of disruptive behavior among the normal population at this age, a few recent studies suggest that reliable and valid diagnosis can be made for children as young as 3 years, 7 months old. The parent interview can also obtain information, as needed, on the situational and temporal variation in the behaviors and their consequences. Following this part of the interview, the examiner should review with the parents any potential problems that might exist in the developmental domains of motor, language, intellectual, academic, emotional, and social functioning.
Achieving this differential diagnosis requires the examiner to have an adequate knowledge of the diagnostic features of other childhood disorders, some of which may present as ADHD. For instance, many children with Autistic Spectrum Disorders or early Bipolar Disorder may be viewed by their parents as ADHD, as the parents are more likely to have heard about the latter disorder than the former ones and will recognize some of those qualities in their children. Questioning about inappropriate thinking, affect, social relations, and motor peculiarities may reveal a more seriously and pervasively disturbed child.
The examiner should also obtain information on the school and family histories. The family history must include a discussion of potential psychiatric difficulties in the parents and siblings, marital difficulties, and any family problems centered on chronic medical conditions, employment problems, or other potential stress events within the family.
Table of contents
Of course, the examiner will want to obtain some information about prior treatments received by the child and his or her family for these presenting problems. Without evidence of such problems, however, referral to a physician for examination usually fails to reveal any further useful treatment information. But when the use of psychiatric medications is contemplated, a referral to a physician is clearly indicated.
First, while ADHD is not caused by family stress or dysfunction, such adverse family factors can contribute to oppositional behavior or frank ODD. Second, a history of certain psychiatric disorders in the extended family might influence diagnostic impressions or treatment recommendations. A family history of Bipolar Disorder in a child with severe behavioral problems might suggest that the child may be at higher risk for the disorder an eight-fold increase in risk and particular medication choices that otherwise might not be considered.
Then, questions about the parents may include how long they have been married, the overall stability of their marriage, whether each parent is in good physical health, whether either parent has ever been given a psychiatric diagnosis, and whether either parent has had a learning disability.
Rating scale selection
In asking about extended family history, the interviewer should include maternal and paternal relatives. Gathering a reliable school history gives the clinician two crucial pieces of the diagnostic puzzle. First, is there evidence of symptoms or characteristics of ADHD in school previous to adolescence? Examiners should ask parents what strategies teachers may have attempted to help the child in class.source
ADHD Rating Scale: What It Is and How to Understand It
They should also inquire about tutoring services, school counselors, study skills classes, or peer helpers. The examiner should find out when and why teachers referred the child for psychoeducational testing. If the child is not doing well in school, the examiner should ask whether school personnel have ever offered an explanation.
As always, the examiner should listen for clues about possible problems with behavioral regulation, impulse control, or sustained attention. If the child has a diagnosed learning disability, are there problems in school that cannot be explained by that learning disability? As part of the general interview of the parent, the examiner must cover the symptoms of the major child psychiatric disorders likely to be seen in ADHD children. A review of the major childhood disorders in the DSM-5 in some semi-structured or structured way is imperative if any semblance of a reliable and differential approach to diagnosis and the documentation of comorbid disorders is to occur.
The examiner must exercise care in the evaluation of minority children to avoid over-diagnosing psychiatric disorders simply by virtue of ignoring differing cultural standards for child behavior. Many parents arrive at the diagnostic evaluation overwhelmed by emotional stress, frustrations with home behaviors, or endless criticisms about the child from the school; thus they may be inclined to say yes to anything.
Starting with ODD and CD questions allows these parents to get some of this frustration out of their system. Thus, when they are asked questions about ADHD, the answers are potentially more reliable and accurate. They may have an agenda that involves obtaining a diagnosis for their child that is not entirely objective. When the clinician asks specific questions about ADHD symptoms, the questions should be phrased in such a way that they are concrete and descriptive.
The foregoing issues should be kept in mind when applying the DSM criteria to particular clinical cases. It helps to appreciate the fact that the DSM represents guidelines for diagnosis, not rules of law or dogmatic prescriptions. Some clinical judgment is always going to be needed in the application of such guidelines to individual cases in clinical practice. To assist clinicians with the differential diagnosis of ADHD from other childhood mental disorders, I compiled a list of differential diagnostic tips see Table 1, below. Under each disorder, I list those features that would distinguish this disorder, in its pure form, from ADHD.
However, many ADHD children may have one or more of these disorders as comorbid conditions with their ADHD; thus the issue here is not which single or primary disorder the child has but what other disorders besides ADHD are present and how they affect treatment planning. Table 1.
- A Whisper in the Dark: Twelve Thrilling Tales by Louisa May Alcott.
- Wheelocks Latin, 6th Edition Revised (The Wheelocks Latin)!
- Eyes Without Country Pb!
- Puzzles in Wood: Simple Patterns for Creating 45 Classics;
- Change Password.
- (ADHDT-2) Attention-Deficit/Hyperactivity Disorder Test, Second Edition?
- Public Financial Management;
- Diagnosing ADHD in Adults.
- Handbook On International Political Economy.
- Superconductivity – Theory and Applications.
- Some Elementary Gauge Theory Concepts.
For years, some clinicians eschewed diagnosing children, viewing it as a mechanistic and dehumanizing practice that merely results in unnecessary labeling. Moreover, they felt that it got in the way of appreciating the clinical uniqueness of each case, unnecessarily homogenizing the heterogeneity of clinical cases. Although there may have been some justification for these views in the past, particularly prior to the development of more empirically based diagnostic criteria, this is no longer the case in view of the wealth of research that went into creating the DSM-5 childhood disorders and their criteria.
This is not to say that clinicians should not document patterns of behavioral deficits and excesses, as such documentation is important for treatment planning; only that this documentation should not be used as an excuse not to diagnose at all. Furthermore, given that the protection of civil rights and entitlements such as access to educational and other services may actually hinge on awarding or withholding the diagnosis of ADHD, dispensing with diagnosis altogether could well be considered professional negligence.
Moreover, billing insurance companies or government agencies for professional services requires the specification of a DSM diagnosis. For these reasons and others, clinicians, along with the parent of each child referred to them, must review in some systematic way the symptom lists and other diagnostic criteria for various childhood mental disorders.
The parental interview may also reveal that one parent, usually the mother, has more difficulty managing the ADHD child than does the other. Such difficulties in child management can often lead to reduced leisure and recreational time for the parents and increased conflict within the marriage and often within the extended family should relatives live nearby. The examiner also should briefly inquire about the nature of parental and family social activities to determine how isolated, or insular, the parents are from the usual social support networks in which many parents are involved.
Research shows that the degree of maternal social insularity is significantly associated with failure in subsequent parent training programs. When present to a significant degree, such a finding might support addressing the isolation as an initial goal of treatment rather than progressing directly to child behavior management training with that family. The first topic in this portion of the interview involves peer relationships and recreational activities. This area could certainly be one of them.
In addition, evidence of impaired peer relationships may lead to important treatment recommendations such as participation in a peer social skills training group or a peer support group. Parents are asked if the child has trouble making or keeping friends, how the child behaves around other children, and how well the child fits in at school. Parents are also asked if they have concerns about the friends with whom their child spends time e.
Finally, they are asked about recreational activities in which the child participates outside school and any problems that occurred during those activities. Compliance with parental requests and parental use of compensatory or motivational strategies also can be explored, especially if the clinician anticipates conducting parent training in child management skills with this family.
These questions also substantiate evidence of impairment in family functioning as well as possible treatment recommendations for parent management training. They are also asked to describe the types of disciplinary strategies they use and whether or not they have tried incentive systems to encourage more appropriate behavior. At a later appointment, perhaps even during the initial session of parent training, the examiner may wish to pursue more details about the nature of the parent-child interactions surrounding the following of rules by the child. When problems are said to occur, the examiner follows up with the list of questions in Table 2, below.
I have found it useful to follow the format set forth in Table 2 in which parents are questioned about their interactions with their children in a variety of home and public situations. When time constraints are problematic, the Home Situations Questionnaire HSQ rating scale from my book, Defiant Children , can be used to provide similar types of information.
After parents complete the scale, they can be questioned about one or two of the problem situations using the same follow-up questions as in Table 2.
The HSQ scale is discussed later. Table 2. Such an approach yields a wealth of information on the nature of parent-child interactions across settings, the type of noncompliance shown by the child stalling, starting the task but failing to finish it, outright opposition and defiance, etc. Some time should always be spent directly interacting with the referred child. The length of this interview depends on the age, intellectual level, and language abilities of the child. For preschool children, the interview may serve merely as a time to become acquainted with the child, noting his or her appearance, behavior, developmental characteristics, and general demeanor.
As with the parents, the children can be queried as to potential rewards and reinforcers they find desirable which will prove useful in later contingency management programs. Children below the age of 9 to 12 are not especially reliable in their reports of their own disruptive behavior. The problem is compounded by the frequently diminished self-awareness and impulse control typical of defiant children with ADHD. Some will report that they have many friends, have no interaction problems at home with their parents, and are doing well at school, in direct contrast with the extensive parental and teacher complaints of inappropriate behavior by these children.
Because of this tendency of ADHD children to underreport the seriousness of their behavior, particularly in the realm of disruptive or externalizing behaviors, the diagnosis of ODD or ADHD is never based on the reports of the child. This is not to say that the office behavior of a child is entirely meaningless. For instance, in a study of four- to six-year-old children, I examined the relationship of office behavior to parent and teacher ratings.
Of these children, were identified at kindergarten registration as being 1. I then classified the children as falling below or above the 93rd percentile on these clinic ratings using data from a normal control group. The children were also classified as falling above or below this threshold on parent ratings of home behavior and teacher ratings of school behavior using the CBCL.
Normal behavior, however, was not necessarily predictive of normal behavior in either parent or teacher ratings. This finding suggests that abnormal or significantly disruptive behavior during a lengthy clinical evaluation may be a marker for similar behavioral difficulties in a school setting. Since this study was completed, standard observation forms for recording child behavior during testing and in school settings have been developed and made commercially available: The Test Observation Form by McConaughy and Achenbach Like parent reports, teacher reports are also subject to bias, and the integrity of the informant, whether it be the parent or teacher, must always be weighed by judging the validity of the information itself.
Many ADHD children have problems with academic performance and classroom behavior and the details of these difficulties need to be obtained. Although this scenario is unlikely to prove feasible for clinicians working outside school systems, particularly in the climate of increasingly prevalent managed health care plans which severely restrict the evaluation time that will be compensated, for those professionals working within school systems, direct behavioral observations can prove very fruitful for diagnosis, and especially for treatment planning.
Teachers should also be sent the rating scales mentioned earlier. They can be sent as a packet prior to the actual evaluation so that the results are available for discussion with the parents during the interview, as well as with the teacher during the subsequent telephone contact or school visit. The settings, nature, frequency, consequences, and eliciting events for the major behavioral problems also can be explored.
The follow-up questions used in the parental interview on parent-child interactions shown in Table 2, above may prove useful here as well. Given the greater likelihood of the occurrence of learning disabilities in this population, teachers should be questioned about such potential disorders. When evidence suggests their existence, the evaluation of the child should be expanded to explore the nature and degree of such deficits as viewed by the teacher. Even when learning disabilities do not exist, children who have ADHD are more likely to have problems with sloppy handwriting, careless approaches to tasks, poor organization of their work materials, and academic underachievement relative to their tested abilities.
Time should be taken with the teachers to explore the possibility of these problems. Child behavior checklists and rating scales have become an essential element in the evaluation and diagnosis of children with behavior problems.
ADHD Rating Scales: What You Need to Know
The availability of several scales with excellent reliable and valid normative data across a wide age range of children makes their incorporation into the assessment protocol quite convenient and extremely useful. As a result, it is useful to mail out a packet of these scales to parents prior to the initial appointment, asking that they be returned on or before the day of the evaluation, as described earlier.
Thus the examiner can review and score the scales before interviewing the parents, allowing vague or significant answers to be elucidated in the subsequent interview and focusing the interview on those areas of abnormality highlighted in the responses to scale items. Numerous child behavior rating scales exist. Despite their limitations, they offer a means of gathering information from informants who may have spent months or years with the child. Apart from interviews, there is no other means of obtaining such a wealth of information with so little investment of time. The fact that such scales provide a means to quantify the opinions of others, often along qualitative dimensions, and to compare these scores to norms collected on large groups of children, is further affirmation of the merits of these instruments.
Nevertheless, behavior rating scales are opinions and are subject to the oversights, prejudices, and limitations on reliability and validity that such opinions may have.
These scales should be completed by parents and teachers. Narrow-band scales that focus specifically on the assessment of symptoms of ADHD should also be employed in the initial screening of children. DuPaul and colleagues collected U. The Home Situations Questionnaire HSQ see my book, Defiant Children , provides a means for doing so, and normative information for these scales is available. As noted earlier, abundant research shows that ADHD is associated with substantial and pervasive deficits in executive functioning EF in daily life, even if those deficits are not always evident on neuropsychological tests used with either children or adults.
It is therefore recommended that clinicians wishing to evaluate EF in children having ADHD use rating scales of EF in daily life that provide a better more ecologically valid means of doing so than do tests. Clinicians should also formally evaluate impairment in major life activities in some standardized way.
The more specialized or narrow-band scales focusing on symptoms of ADHD as well as the HSQ and SSQ can be used to monitor treatment response when given prior to, throughout, and at the end of parent training. They can also be used to monitor the behavioral effects of medication on children with ADHD. Most items are similar to those on the parent and teacher forms of the CBCL except that they are worded in the first person.
Guide to Assessment Scales in Attention-deficit/Hyperactivity Disorder
A later revision of this scale Cross-Informant Version; Achenbach, now permits direct comparisons of results among the parent, teacher, and youth self-report forms of this popular rating scale. Research shows that a major area of life functioning affected by ADHD is the realm of general adaptive behavior. This domain often includes:. So substantial and prevalent is this area of impairment among children with ADHD that some researchers have even argued that a significant discrepancy between IQ and adaptive behavior scores expressed as standard scores may be a hallmark of ADHD.
Several instruments are available for the assessment of this domain of functioning. The Vineland Adaptive Behavior Inventory is probably the most commonly used measure for assessing adaptive functioning. It is an interview, however, and takes considerable time to administer. As noted earlier, children with ADHD often demonstrate significant difficulties in their interactions with peers, and such difficulties are associated with an increased likelihood of persistence of their disorder. Most of these assessment methods have no norms and thus would not be appropriate for use in the clinical evaluation of children with ADHD.
For clinical purposes, rating scales may offer the most convenient and cost-effective means for evaluating this important domain of childhood functioning. The more recently developed Barkley Functional Impairment Scale — Children and Adolescents also covers various domains of social life and has U. The latter also has norms and a software scoring system, making it useful in clinical contexts. These will need to be addressed during treatment. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed. BMC Psychiatry. J Atten Disord.
J Clin Psychol. Arch Gen Psychiatry. Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. Am J Psychiatry. Biol Psychiatry. J Abnorm Child Psychol. Continuous performance tests are sensitive to ADHD in adults but lack specificity. A review and critique for differential diagnosis. Ann N Y Acad Sci. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder.
To view other topics, please sign in or purchase a subscription. Complete Product Information. Johns Hopkins Psychiatry Guide. Tags Type your tag names separated by a space and hit enter. Johns Hopkins Guide , www.
Related Guide to assessment scales in Attention-deficit/Hyperactivity disorder
Copyright 2019 - All Right Reserved