Thomas J. Power

Parent ratings of attention-deficit/hyperactivity disorder symptoms: Factor structure and normative data.

Changes in the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) have necessitated the creation of new measures for clinical assessment. The factor structure of a parent rating scale containing the 18 symptoms of ADHD was examined in this study. Factor analyses and assessment of differences in ADHD ratings across sex, age, and ethnic group were conducted using a sample of 4666 participants ranging in age from 4 to 20 years old who attended kindergarten through 12th grade in 22 school districts across the United States. Two factors (Inattention and Hyperactivity–Impulsivity) were derived and normative data for a nationally representative sample are presented. A higher frequency of ADHD symptoms was found for boys, younger children, and African-American participants. Potential uses of this scale in clinical practice and research are discussed.

Teacher ratings of Attention-Deficit/Hyperactivity Disorder symptoms: Factor structure and normative data.

Comprehensive assessment of attention-deficit/hyperactivity disorder (ADHD) symptoms includes parent and teacher questionnaires. The ADHD Rating Scale-5 was developed to incorporate changes for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This study examined the fit of a correlated, 2-factor structure of ADHD (i.e., DSM-5 conceptual model) and alternative models; determined whether ADHD symptom ratings varied across teacher and child demographic characteristics; and presented normative data. Two samples were included: (a) 2,079 parents and guardians (1,131 female, 948 male) completed ADHD symptom ratings for children (N = 2,079; 1,037 males, 1,042 females) between 5 and 17 years old (M = 10.68; SD = 3.75) and (b) 1,070 teachers (766 female, 304 male) completed ADHD symptom ratings for students (N = 2,140; 1,070 males, 1,070 females) between 5 and 17 years old (M = 11.53; SD = 3.54) who attended kindergarten through 12th grade. The 2-factor structure was confirmed for both parent and teacher ratings and was invariant across child gender, age, informant, informant gender, and language. In general, boys were higher in symptom frequency than girls; older children were rated lower than younger children, especially for hyperactivity-impulsivity; and non-Hispanic children were rated higher than Hispanic children. Teachers also rated non-Hispanic African American children higher than non-Hispanic White, Asian, and Hispanic children. Non-Hispanic White teachers provided lower hyperactivity-impulsivity ratings than non-Hispanic, African American, and Hispanic teachers. Normative data are reported separately for parent and teacher ratings by child gender and age. The merits of using the ADHD Rating Scale-5 in a multimodal assessment protocol are discussed. (PsycINFO Database Record

Patterns of comorbidity associated with subtypes of attention-deficit/hyperactivity disorder among 6- to 12-year-old children.

OBJECTIVE To study externalizing and internalizing comorbidity patterns in 6- to 12-year-old children with attention-deficit/hyperactivity disorder (ADHD) combined subtype (n = 27), ADHD inattentive subtype (n = 26), and a normal control group (n = 33). METHOD Children were assigned to groups on the basis of results of a parent structured interview, which reflected DSM-IV diagnostic criteria, and teacher ratings of ADHD symptoms. Comorbid problems were assessed via parent and child structured interviews and parent and teacher behavior ratings. RESULTS Logistic regression analyses and multivariate analyses of covariance revealed that (1) children in the ADHD combined group were significantly more likely to have a diagnosis of oppositional defiant disorder and conduct disorder and had significantly higher scores on parent and teacher ratings of externalizing problems than children in the ADHD inattentive and control groups, (2) children in the ADHD combined and ADHD inattentive groups had significantly higher scores on parent and teacher ratings of internalizing problems than children in the control group, and (3) children in the clinical groups did not differ with regard to internalizing disorders. CONCLUSIONS The results from this study indicate that a significant comorbidity exists between ADHD combined and oppositional defiant disorder/conduct disorder. Contrary to previous studies that were conducted using DSM-III diagnostic criteria for ADHD, no differences were found between ADHD combined and ADHD inattentive subtypes regarding internalizing disorders.

Assessing culturally different students for attention deficit hyperactivity disorder using behavior rating scales.

Behavior rating scales are commonly used in the assessment of attention deficit-hyperactivity disorder (ADHD). However, there is little information available concerning the extent to which scales are valid with culturally different students. This study explored the use of the ADHD-IV Rating Scale School Version with male Caucasian (CA) and African American (AA) students from ages 5 to 18 years. Teachers rated AA students higher on all symptoms across all age groups. LISREL analysis indicated that scale does not perform identically across groups. This was supported by the results of multidimensional scaling with suggested that there is a different relation between items across groups. Implications for research and practice are discussed.

Reliability and validity of parent and teacher ratings of Attention-Deficit/Hyperactivity Disorder symptoms.

The reliability and criterion-related validity of the Home and School versions of the AD/HD Rating Scale-IV were evaluated in a nonreferred sample of 71 students. Parent and teacher ratings were obtained 4 weeks apart at a time contemporaneous with observations of classroom behavior and academic productivity. Results indicated adequate levels of internal consistency, test-retest reliability, and cross-informant agreement for both parent and teacher ratings. Teacher ratings were significantly correlated with classroom observational data, and parent ratings were primarily related to behavior ratings. The discriminant validity of these scales also was examined in a sample of 92 clinic-referred children. Both the Home and School versions of the AD/HD Rating Scale-IV were found to discriminate significantly between children with and without AD/HD. The AD/HD Rating Scale-IV appears to have adequate psychometric properties for the screening and assessment of AD/HD.

Evaluating Attention Deficit Hyperactivity Disorder using multiple informants : The incremental utility of combining teacher with parent reports

In a sample of students referred to a school-based Pupil Assistance Committee, the Inattention and Hyperactivity-impulsivity factors of the Attention Deficit Hyperactivity Disorder (ADHD) Rating Scale-IV were used to predict diagnostic status, determined by a parent-reported diagnostic interview and teacher rating scale. Results of logistic regression and receiver operating curve analyses indicated that the Inattention and Hyperactivity-Impulsivity factors differentiated students with ADHD from controls and distinguished children with different ADHD subtypes. Symptom utility estimates demonstrated that a single informant approach was best suited for ruling out ADHD, whereas a combined informant method was optimal for positively diagnosing this disorder. Methods for determining the incremental utility of combining teacher with parent reports were demonstrated.

Service Utilization among ethnic minority children with ADHD: a model of help-seeking behavior.

Despite a significant increase in the number of children and adolescents who receive clinical services for attention deficit hyperactivity disorder (ADHD), there is still a considerable level of unmet need. Children of ethnic minority status continue to lag well behind their non-minority counterparts in the rate of diagnosis and treatment for the disorder. Racial/ethnic disparities in service use are the result of a combination of access barriers and individual, cultural, and societal factors. The ADHD Help-Seeking Behavior Model is proposed as a framework for understanding factors that may be predictive of service use. Variables specific to ADHD and ethnic-minority populations are integrated within the framework of a four-stage pathway model encompassing problem recognition, decision to seek help, service selection, and service use. The authors argue that by systematically addressing factors related to service use for each ethnic minority group, more effective intervention initiatives can be developed to improve identification and treatment for ADHD among underserved children.

A Family-School Intervention for Children with ADHD: Results of a Randomized Clinical Trial.

OBJECTIVE Accumulating evidence highlights the importance of using psychosocial approaches to intervention for children with attention-deficit/hyperactivity disorder (ADHD) that target the family and school, as well as the intersection of family and school. This study evaluated the effectiveness of a family-school intervention, Family-School Success (FSS), designed to improve the family and educational functioning of students in Grades 2-6 who meet criteria for ADHD combined and inattentive types. Key components of FSS were conjoint behavioral consultation, daily report cards, and behavioral homework interventions. METHOD FSS was provided over 12 weekly sessions, which included 6 group sessions, 4 individualized family sessions, and 2 school-based consultations. Participating families were given the choice of placing their children on medication; 43% of children were on medication at the time of random assignment. Children (n = 199) were randomly assigned to FSS or a comparison group controlling for non-specific treatment effects (Coping With ADHD Through Relationships and Education [CARE]). Outcomes were assessed at post-intervention and 3-month follow-up. The analyses controlled for child medication status. RESULTS FSS had a significant effect on the quality of the family-school relationship, homework performance, and parenting behavior. CONCLUSIONS The superiority of FSS was demonstrated even though about 40% of the participants in FSS and CARE were on an optimal dose of medication and there were significant time effects on each measure. This relatively brief intervention produced effect sizes comparable to those of the more intensive Multimodal Treatment Study of Children With ADHD (MTA) behavioral intervention.

The predictive validity of parent and teacher reports of ADHD symptoms.

The objectives were to evaluate the ability of the Inattention and Hyperactivity–Impulsivity factors of the ADHD Rating Scale-IV to differentiate children with ADHD from a control group and to discriminate children with different subtypes of ADHD. Also, we sought to determine optimal cutoff scores on the teacher and parent versions of this scale for making diagnostic decisions about ADHD. In a sample of 92 boys and girls 6 to 14 years of age referred to a regional ADHD program, we assessed ADHD diagnostic status using categorical and dimensional approaches as well as parent- and teacher-report measures. Logistic regression analyses showed that the Inattention and Hyperactivity–Impulsivity factors of the ADHD Rating Scale-IV were effective in discriminating children with ADHD from a control group and differentiating children with ADHD, Combined Type from ADHD, Inattentive Type. Although both teacher and parent ratings were significantly predictive of diagnostic status, teacher ratings made a stronger contribution to the prediction of subtype membership. Using symptom utility estimates, optimal cutoff scores on the Inattention and Hyperactivity–Impulsivity scales for predicting subtypes of ADHD were determined.

Assessing ADHD and Comorbid Disorders in Children: The Child Behavior Checklist and the Devereux Scales of Mental Disorders

Evaluated discriminant validity and clinical utility of selected subscales of the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) and the Child Behavior Checklist (CBCL; Achenbach, 1991a) in 228 children referred to a clinic for the evaluation and treatment of attention deficit hyperactivity disorder (ADHD). The DSMD is a multiaxial behavior rating scale that measures symptomatology for a broad range of child psychopathology as described in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-R-III] and 4th ed. [DSM-IV]; American Psychiatric Association, 1987, 1994). Discriminant function analyses as well as sensitivity, specificity, and predictive power analyses were computed to evaluate the discriminant validity and clinical utility of selected DSMD and CBCL subscales for assessing ADHD, oppositional defiant disorder (ODD), and anxiety disorders. Results indicated that the DSMD compared very favorably with the CBCL in the ability to discriminate between children with ADHD and those without ADHD and between children with comorbid ODD and anxiety disorders and children who did not meet criteria for these disorders. The DSMD Attention subscale may be somewhat better at ruling in ADHD combined subtype (ADHD-C) and ADHD inattentive subtype (ADHD-I) than the CBCL Attention Problems subscale, but the CBCL Attention Problems subscale may have slightly better utility than the DSMD Attention subscale in ruling out these subtypes. Both the CBCL and DSMD were more useful for ruling out than for ruling in ODD and anxiety disorders.