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How Well Do Rating Scales Identify Children With ADHD?
BOSTON—Sole reliance on rating scales by parents and teachers to help identify children with ADHD is “likely to misidentify many children as not having ADHD when, in fact, they do, thereby complicating subject recruitment,” according to research presented at the 54th Annual Meeting of the American Academy of Child and Adolescent Psychiatry.
Arthur D. Anastopoulos, PhD, Professor of Psychology and Director of the ADHD Clinic at the University of North Carolina at Greensboro, and colleagues sought to examine the degree to which various assessments of ADHD in children provided consistent findings. The investigators expected that results from a single informant (ie, parent or teacher) would be consistent regardless of the assessment used, and they anticipated less correlation between different informants and between questionnaire results and formal interview-based diagnosis by an expert panel.
The study included 158 children, ages 5 to 12, who met DSM-IV criteria for ADHD based on parental responses to a computerized version of the Diagnostic Interview Schedule for Children–Fourth Edition (C-DISC-IV) and who had evidence of developmental deviance per the DSM-IV inattention and hyperactivity subscales of the Conners Parent and Teacher Rating Scales. Participants included 105 probands and 53 siblings—107 boys and 51 girls; 83% were Caucasian, 11% were African American, and the remaining children were from varying ethnic and racial backgrounds.
RATING THE ADHD SCALES
Parents and teachers were asked to fill out two questionnaires: the ADHD Rating Scale–IV (ADHD RS) and the Behavior Assessment System for Children, Second Edition (BASC-2). The results from these questionnaires were compared between parents and teachers, as well as with consensus diagnoses made by a panel of three senior-level project investigators based on interview and rating scale data.
Ratings collected from a single informant were highly correlated across scales for parents and teachers. Parent-teacher correlations were lower. “Parent-teacher associations were particularly weak with respect to the various measures of inattention,” reported Dr. Anastopoulos and colleagues. The strength of these associations remained constant when the child’s medication status was taken into account.
“The results of this study suggest that ADHD RS and BASC-2 data obtained from the same informant correlate highly with Conners rating scale results,” the researchers stated. “Regardless of which rating scale is used, cross-informant agreement was low to moderate for hyperactive-impulsive ratings and low to nonsignificant for inattention…. At a categorical level, ADHD classifications determined on the basis of BASC-2 and ADHD RS scores provide good correspondence with classifications of ADHD as determined by the C-DISC-IV and by expert panel review. In contrast, rating scale determinations of not having ADHD correspond rather poorly with C-DISC-IV and expert panel classifications, with as many as 56.5% of the parent ratings and 90% of the teacher ratings failing to agree.”
According to Dr. Anastopoulos, the results indicate several avenues for further study, including the development of more sensitive and accurate parent and teacher assessments, investigation of ways to ensure that children who are misdiagnosed with the use of existing assessments receive personal evaluations from mental health professionals, and more detailed evaluation of the methods used by the panel to make final diagnosis.
—Rose Fox
Suggested Reading
Adler LA, Faraone SV, Spencer TJ, et al. The reliability and validity of self and investigator ratings of ADHD in adults. J Atten Disord. 2007 Nov 19; [Epub ahead of print].
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