ADHD rating scale

The ADHD Rating Scale (ADHD-RS) is a parent-report or teacher-report inventory created by George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid[1] consisting of 18–90 questions regarding a child's behavior over the past 6 months.[1] The ADHD Rating Scale is used to aid in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children ranging from ages 5–17.[1]

For other topics with the initialism ARS, see Ars.
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The ADHD-RS is currently in its fifth version in correlation with the DSM-5.

Overview

The ADHD-RS, is an 18-question self-report assessment that takes about five minutes to complete.[1] Each question measures the frequency of the behavior, in which the respondent is asked to indicate whether the behavior occurs "always or very often", "often", "somewhat", or "rarely or never". The questionnaire is intended to be filled out by parents and teachers of the child or adolescent.[1] The first nine items ask questions about behavior related to inattention (e.g., "has difficulty organizing task and activities"). The second set of nine items ask questions about behavior related to symptoms of hyperactivity and impulsivity (e.g., "talks excessively"). The last question asks if the behaviors were present before age seven. Some examples of ADHD behaviors that are measured by the scale includes; difficulty to focus on tasks, organizing, or not being able to pay attention, squirming, fidgeting, always impatient, can't wait for their turn, and often interrupting others. The ADHD Rating scale has impacted the world of clinical psychology by providing an accurate and valid measure that is able to identify the presence of ADHD in children.[2] It is also helpful in identifying the subtype (predominantly Inattentive, predominantly Hyperactive-Impulsive, and Combined) of the disorder.[2]

Development and history

Attention deficit/ hyperactivity disorder (ADHD) is one of the most prevalent neurological disorders found in children.[3]

The ADHD-RS was created by George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid to address the need for an effective evaluation for children and adolescents suspected of having ADHD.[3] The diagnostic criteria were developed through a selection of items from general rating scales such as the Child Behavior Checklist.[4] The list initially contained 14 items and grew to the 18 questions we have today.[3][4]

The assessment largely serves the purpose of matching parent and teacher observations of ADHD symptoms to DSM-IV criteria of ADHD.[5] It was developed in tandem with the Academic Performance Rating Scale (APRS) to be used as a complementary system of identification for potential behavioral disorders in the classroom.[6] Class performance is still a diagnostic factor though evaluated through the more comprehensive DSM-5 criteria;[7] as children with ADHD are likely to find issue in scholastic performance, personal conduct, and maintaining social relationships.[3][8]

DSM-IV outlines three subtypes of ADHD: ADHD combined type, ADHD predominantly inattentive, and ADHD predominantly hyperactive-impulsive. The ADHD-RS separates domain scores of "Inattention" and "Hyperactivity-Impulsivity" which ultimately results in three scores for "Inattention," Hyperactivity-Impulsivity", and "Total".[5] DSM-IV also organizes diagnostic criteria into two categories of Inattention and Hyperactivity-Impulsivity, each of which includes nine symptoms.[3] The eighteen questions of the ADHD-RS were written to reflect each symptom of both categories.[3]

With the release of DSM-V, the questionnaire was adjusted to be in line with the new criteria established.[7]

Questionnaire versions

The four versions ask age-appropriate questions about hyperactivity and inattention in specific settings.[1]

Home
There are two home versions — Child (ages 5–10) and Adolescent (ages 11–17). These are intended to be completed at home by a parent or guardian. The questions are specific to situations and activities in the home setting.[1]
School
There are two school versions — Child (ages 5–10) and Adolescent (ages 11–17). These are intended to be completed at school by a teacher. The questions are specific to situations and activities in the school setting, such as staying in one's seat or completing schoolwork.[1]

Reliability and validity

Reliability
Rubric for evaluating norms and reliability for the ADHD Rating Scale[lower-alpha 1]
CriterionRating (adequate, good, excellent, too good[lower-alpha 2])Explanation with references
NormsAdequate
Internal consistency (Cronbach's alpha, split half, etc.)ExcellentAlphas were > .90 for the School and Home versions.[1]
Inter-rater reliabilityLess than adequatereliability between parents and teachers was =.41[1]
Test-retest reliability (stability)AdequateTotal score =.85 over a 4-week period[1]
RepeatabilityNot publishedNo published studies formally checking repeatability

Validity
Evaluation of validity and utility for the ADHD Rating Scale[lower-alpha 1]
CriterionRating (adequate, good, excellent, too good[lower-alpha 2])Explanation with references
Content validityAdequateCovers DSM diagnostic symptoms for both hyperactivity and impulsivity subtypes and combined type.[1]
Construct validity (e.g., predictive, concurrent, convergent, and discriminant validity)ExcellentIn the clinical setting the predictive validity for the combined subscale for parents and teachers were 60% and 65% accuracy, respectively. This indicates that the assessment has statistically significant accuracy at identifying the diagnosis.[11]
Discriminative validityAdequateStatistically significant discrimination in mean rating between three groups of participants that identified as ADHD Combined, ADHD Inattentive and no ADHD.[11]
Validity generalizationGoodUsed as other-report from both teachers and parents; used in school settings as well as clinical setting; assessment was normed on a random sample of the population that included many different ethnic and demographic backgrounds.[11]
Treatment sensitivityAdequateCan be used in order to access progression of ADHD symptoms throughout treatment.[11]
Clinical utilityGoodEasily accessible through the purchase of the handbook that includes the assessment and scoring information with permission to photocopy, strong psychometrics. Completion and scoring are quick and easy.[1]
  1. Table from Youngstrom et al.,[9] extending Hunsley & Mash, 2008.[10]
  2. New construct or category.

Impact

The ADHD Rating Scale has provided a quick and easy assessment for clinicians to use in order to diagnose ADHD according to the DSM criteria.[1] The creation of this assessment also provided a consistent way for clinicians to diagnose ADHD in children. This assessment is used in both clinical and school settings to measure the presence of ADHD as well as the subtype that may be present.[1] The measure can also be used to measure the presence and continuation of symptoms throughout treatment.[12] This assessment has also been used as the basis for studies covering a wide variety of topics related to ADHD.[13]

Use in other populations

ADHD Rating Scale-IV

The ADHD RS- IV is widely used in the U.S. in English; however, because of the increasing population of Latino-Americans in the U.S., the ADHD Rating Scale was also translated into Spanish to accommodate those speaking Spanish as their first language.[1] Also, many other countries have already translated and validated the ADHD scale into their primary spoken language. According to the Archives of Clinical Psychiatry in São Paulo, the TDAH (Portuguese abbreviation for ADHD)[14] was fully validated in Brazil by the end of 2006.

Limitations

Ratings of ADHD symptoms on rating scales in general are subjective. Teachers and parents may use different subjective criteria to define symptoms, and may not take context of symptoms into account when making ratings.[12] Furthermore, the validity of the ARS is acceptable,[1] but the normative sample used to calculate this statistic was composed of children aged 5 to 14, and thus it cannot be generalized beyond age range.[11]

According to an accuracy study performed Pediatrics Association in 2016, from all scales they examined the ASQ is the most effective scale that can be used to diagnose the disease, due to its high brevity and high diagnostic accuracy.[15] A Manual called "Conners Comprehensive Behavior Rating Scales", released in 2017, states that results from discriminative validity analysis showed that the accuracy of the scores to be at 78% across all forms used to diagnose the disease.[16]

There are also questions about how well items on the ARS follow explicit DSM criteria. Specifically, one of the hyperactivity items does not specify that in adolescents, thoughts of restlessness are sufficient, rather than excessive behavioral movement. This lack of specification does not map directly onto DSM criteria.[11]

This assessment can be accessed by purchasing the ADHD Rating Scale handbook, which includes copies of the Teacher and Parent versions with permission to photocopy for clinical use.

See also

References
  1. DuPaul, G. J.; Power, T. J.; Anastopoulos, A. D.; Reid, R. (1998). ADHD Rating Scale-IV: Checklists, norms, and clinical interpretation. New York: Guilford. Retrieved 9 September 2016.
  2. Taylor, Abigail; Deb, Shoumitro; Unwin, Gemma (February 12, 2011). "Scales for the identification of adults with attention deficit hyperactivity disorder (ADHD): A systematic review". Research in Developmental Disabilities. 32 (3): 924–38. doi:10.1016/j.ridd.2010.12.036. PMID 21316190.
  3. DuPaul, G. J.; Power, T. J.; Anastopoulos, A. D.; Reid, R. (1998). ADHD Rating Scale-IV: Checklists, norms, and clinical interpretation. New York: Guilford. Retrieved 9 September 2016.
  4. DuPaul, George J.; Rapport, Mark D.; Perriello, Lucy M. (1991-06-01). "Teacher Ratings of Academic Skills: The Development of the Academic Performance Rating Scale". School Psychology Review. 20 (2): 284–300. doi:10.1080/02796015.1991.12085552. ISSN 2372-966X.
  5. Dupaul, George; Power, Thomas; Anastopoulos, Arthur; Reid, Robert (1998). "ADHD Rating Scale-IV". The fifteenth mental measurements yearbook. New York, NY: Guilford Publications, Inc – via EBSCOhost.
  6. DuPaul, George J.; Rapport, Mark D.; Perriello, Lucy M. (1991-06-01). "Teacher Ratings of Academic Skills: The Development of the Academic Performance Rating Scale". School Psychology Review. 20 (2): 284–300. doi:10.1080/02796015.1991.12085552. ISSN 2372-966X.
  7. American Psychiatric Association (2013-05-22). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8.
  8. Smith, B.H.; Barkley, R.A.; Shapiro, C.J. (2007). "Attention-Deficit/Hyperactivity Disorder". In Mash, Eric J.; Barkley, Russell A. (eds.). Assessment of Childhood Disorders (4th ed.). New York, NY: Guilford Press. pp. 53–131. ISBN 978-1593854935.
  9. Youngstrom, E.A.; et al. "Evidence-Based Assessment". Eric A. Youngstrom, Ph.D. The University of North Carolina at Chapel Hill.
  10. Hunsley, John; Mash, Eric (2008). A Guide to Assessments that Work. New York, NY: Oxford Press. ISBN 978-0195310641.
  11. Dupaul, George; Power, Thomas; Anastopoulos, Arthur; Reid, Robert (1998). "ADHD Rating Scale-IV". The fifteenth mental measurements yearbook. New York, NY: Guilford Publications, Inc – via EBSCOhost.
  12. Smith, B.H.; Barkley, R.A.; Shapiro, C.J. (2007). "Attention-Deficit/Hyperactivity Disorder". In Mash, Eric J.; Barkley, Russell A. (eds.). Assessment of Childhood Disorders (4th ed.). New York, NY: Guilford Press. pp. 53–131. ISBN 978-1593854935.
  13. Weisler, Richard H.; Adler, Lenard A.; Kollins, Scott H.; Goodman, David W.; Hamdani, Mohamed; Dirks, Bryan; Childress, Ann C. (2013-12-09). "Analysis of individual items on the attention-deficit/hyperactivity disorder symptom rating scale in children and adults: the effects of age and sex in pivotal trials of lisdexamfetamine dimesylate". Neuropsychiatric Disease and Treatment. 10: 1–12. doi:10.2147/NDT.S47087. PMC 3862743. PMID 24363557.
  14. Mattos, Paulo; Segenreich, Daniel; Saboya, Eloísa; Louzã, Mário; Dias, Gabriela; Romano, Marcos (2006). "Adaptação transcultural para o português da escala Adult Self-Report Scale para avaliação do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos". Archives of Clinical Psychiatry (São Paulo) (in Portuguese). 33 (4): 188–194. doi:10.1590/S0101-60832006000400004. ISSN 0101-6083.
  15. Chang, Ling-Yin; Wang, Mei-Yeh; Tsai, Pei-Shan (2016-03-01). "Diagnostic Accuracy of Rating Scales for Attention-Deficit/Hyperactivity Disorder: A Meta-analysis". Pediatrics. 137 (3): e20152749. doi:10.1542/peds.2015-2749. ISSN 0031-4005. PMID 26928969.
  16. "Conners CBRS 2017". issuu.com. Retrieved 2019-12-10.
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